July 29, 2021

Who Pays for My Health Insurance While on Workers’ Comp?

Individuals with workers' compensation claims often ask, "Who pays for my health insurance while on workers comp?" Such a question is understandable as the claimant will likely need medical care and wants to know who is responsible for payment.

The following post provides an answer for Maryland residents who are protected from employer retribution after filing a workers' compensation claim. They, however, are not guaranteed the continuation of their employer-provided health insurance with the exception of two specific criteria being met outlined below.

health insurance written in chalk on table top with stethoscope

Health Insurance Coverage and Workers' Comp

As mentioned previously, Maryland employers are prohibited from stripping an employee of their benefits, such as health insurance, upon them going out after a work-related injury. That said, many employer-provided health insurance plans include requirements for hours worked, which often presents an issue for individuals on disability-related leave.
This situation presents two options: pursuing Family Medical Leave Act (FMLA) protections or Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.

Family Medical Leave Act (FMLA) Protections: Who are They For?

FMLA offers seriously injured employees certain legal protections. Specifically, injured employees may be able to take up to 12 weeks of leave. During this period, an employee’s job status as well as their health insurance coverage is legally protected.

To be eligible for these protections, an employee must have:

  • Been with their employer for at least one year
  • Worked at least 1250 hours over the previous year
  • They work at a location with at least 50 employees within a 75-mile radius

The employee cleared for FMLA will continue to pay their portion of the health insurance premium on a monthly basis; their employer will do the same.

COBRA Coverage Options

This form of temporary extension of an individual's existing, employer-provided health insurance coverage is offered upon a change in employment status: termination, layoff, or longer than 12 weeks of disability-related leave. The employee will be required to pay the entire cost of a plan's premium during the covered 18-month covered period.

How We Can Help

Working with an experienced workers' compensation law office like Shultz Legal can help ensure you or a loved one get a just outcome where your medical expenses are covered and benefits are protected. Call (410) 505-7627 or submit a request for a case consultation using our online contact form.