The Rights to Health Care Benefits for Injured Workers

The Rights to Health Care Benefits for Injured Workers

This is episode number 29 of the Inland Empire Workers’ Compensation Lawyer livestream podcast. My name is Attorney Alexander Napolin. I’m here with my co host, Jorge Ibuado. We discuss important information that employees in California should know about their workers’ compensation and employment rights. And on this episode, we’re discussing the rights that employees have to their health care benefits when they’re out on workers’ compensation. So, if you’ve been injured at work, and you’re off of work, because your employer can’t accommodate you, you’re not earning any money. What are your rights to keep your own private health insurance through your employer? Jorge, what rights do employees have?

Many Factors Determine Your Right to Healthcare Benefits

You know, this is a pretty sad topic, Alex, because unfortunately, employees don’t have the rights to keep their insurance under their employer, if they’re out for workers compensation. And they’re not working, okay? Usually employers have a specific policy, and you have to look at your employer’s policy. So go ahead and look at your manual or talk to your HR department to see what that policy is, it also changes if it’s union. So there are other factors that come into play. But if you don’t work a minimum amount of hours, then you don’t qualify for the insurance that your employer provides. So once you don’t work that minimum amount of hours, then you might lose your health care coverage under your employer.

Most Employees Are Surprised to Learn Healthcare Isn’t Always Protected

Thank you for that explanation, Jorge, because this is a question that Jorge and I are asked all the time on almost every single case where we have an employee who’s off work for an extended period of time, they’re asking us, “Hey, my employer is telling me, we’re not going to keep paying for your health insurance,” or “You don’t qualify for your own health insurance.” Now, we’re not talking about treatment under workers; comp, no, we’re talking about health care. Health insurance, like Blue Shield, Blue Cross, Aetna, Health Net, Kaiser, these types HMOs that are very expensive. Maybe your employer provides that as a benefit, for your work, maybe it’s deducted from your paycheck, and you’re not earning a paycheck anymore. Now, you’re not getting the health insurance. And these are the types of situations that cause a lot of stress. So if you’re out there, and this has just happened to you, and you don’t have a lawyer to go to you come across this live stream, or this podcast, and you’re in California, oh my gosh, you’re realizing that maybe you don’t have rights to this coverage, it’s time that you should definitely seek attorney representation, because you’re going to need to figure out something to do. So thanks for that explanation, George. But are there any situations where it could stay on?

A Note About The Family Medical Leave Act (FMLA)

There are situations where it can stay on for a period of time. Like, for instance, if you qualify for the Family Medical Leave Act: FMLA. Most people know it as I believe you get an extension for up to 12 weeks of coverage. But after that, you know, after that ends, then once again, the employer is well within the right. Absent any outside issues that we’ve discussed before union that kind of thing. They’re well within their rights to take you off of their insurance and stop giving you those benefits.

Experienced Workers Compensation Lawyers Can Help

It’s based on employer to employer depending on what their policies are. Depending on if you’re have a union contract, depending on if you qualify for FMLA, which is the Family Medical Leave Act, which is a federal act that protects you if you’re too sick to work, or you have to take care of a family member because they’re too sick. The Family Medical Leave Act will provide job protection. That’s something that a lot of employees are never offered. So if you’re out there, and you’ve been working for the employer, and you’re on workers comp, you’re too sick to work because of an industrial condition, you might qualify for FMLA now has your employer offered that to you? That’s something that you need to discuss with a lawyer. Because, the specific qualifications for FMLA, whether or not your employer offered those to you, whether or not your employers follow the law, is something that needs to be analyzed by a lawyer. So if you’re out there, you’ve been injured at work, you’re off of work, you’re losing your health insurance, or you’re concerned about your health insurance, your own private health insurance, because you have a non-industrial or non-work related condition, you need to dial the Injury Helpline at 844-984-8414 because the information we’re discussing with you here is general in nature only. It’s meant to help you, to guide you, to give you a better understanding of the whole situation you’re facing. But in order for you to determine what your specific legal rights are, you need to dial the injury Helpline at 844-984-8414 or visit our website www.workerscompensationlawyer Jorge you have anything you want to add?

A Note About Health Plan Termination

Of course, yeah. You know, a lot of people know FMLA. As far as you know, you’ve had a baby, you might be able to qualify for FMLA through that way. Maybe even you know you’ve lost a loved one, a father, mother or someone close to you in your immediate family that usually also qualifies you for FMLA. For workers’ compensation, the way you qualify for FMLA is worker’s compensation can be seen as a “serious health condition,” quote unquote. So that might qualify you for FMLA. Now, if an employer decides to terminate your insurance, they have to notify you, okay? They have to notify you that they’re terminating your insurance, and they also have to provide you with an option to be covered through the COBRA health insurance. Right. So a lot of people have heard about COBRA, a lot of people have not. Alex, have you heard about COBRA?

Cal Cobra As An Extension of HealthCare Benefits

I have, you know, if you’ve been if working and you’ve been laid off, or you’ve been terminated, or you’ve had to take an extended leave of absence, your employer cuts off your health insurance. The federal law says that your employer has to offer you some health insurance at your own expense, right? You can’t just lose your health coverage, although you can lose your employer paying for it right. And that’s Cobra, there’s also Cal COBRA, which gives you a little bit more in terms of length of time you can stay on that. But that’s a topic for another video. What you have to understand is that your employer, if they cut your health insurance off, should be offering you COBRA.

Limitations of COBRA

They should. It’s the the federal continuation of health coverage. So like you said, Alex, it’s a federal program. The only thing is that it’s not cheap. It’s very expensive. So that’s more bad news. Sorry to be the bearer of bad news. Today, we’re just providing information to you don’t kill the messenger. But COBRA is not cheap, but you are eligible for it. And it might be an option for some people.

How A Workers’ Compensation Lawyer Can Help

And these options should be discussed with the lawyer. We know how to help you get on state disability. If your workers’ compensation claim’s denied. You might qualify for a subsidized plan on the insurance exchanges. You might qualify for MediCal through the Department of Health Care Services in California. So maybe your incomes dropped to a level because, and you’ve lost your health coverage you can’t afford COBRA, you can’t afford anything. Because COBRA is going to be as expensive as your health plan plus a little. I think it’s five more percent they can add on even higher. I’ll have to double check that, but I’ll put it in the description below. The specifics of COBRA, we’ll put a link off to the government website on that.

Yeah, which doesn’t make sense to me because now you’re making less money, you’re off of work, or you might have lost your job, and now you need Cobra, and you have to pay more. You know, so that something that doesn’t make sense, but that’s the way it is.

Not all laws are labor friendly, right? That’s why you need a lawyer advocating for you, if all the laws just gave you everything that you should get and it was just easy to get then you wouldn’t need lawyers like Jorge Ibuado and myself. That’s why we’re here to help you.

And we have a website for this podcast, which is a resource, you can go on there. You can read our blogs, you can check out our videos, but remember, it’s not legal advice. It’s general in nature only. If you need to reach us directly get a free consultation, dial the Injury Helpline 844-984-8414. Visit that website We’ll put that in the description below. And I think that’s it for the episode.

Learn more about COBRA