Worker’s compensation is not a guarantee of health insurance coverage. At least not under Wisconsin law. Many injured workers mistake worker’s compensation insurance for health insurance after suffering a work injury. Not true. Worker’s compensation is just insurance for the specific body part injured. It is not general health insurance for any other illiness/sickenss, and it certainly is not insurance for the worker’s family or children.
There is no obligation under Wisconsin law for an employer to continue to pay health insurance premiums or provide health insurance coverage when a worker is out after a work injury. A recent attempt to require an employer to continue its health insurance coverage while a worker is recovering failed at the legislative level. Thus, a worker could be off work after an injury and find that their health insurance benefits have been terminated (or that the employer is not paying their premium portion…which could be cost prohibitive).
In many worker’s compensation claims, the worker’s compensation carrier sends an injured worker to an “independent” medical examiner who denies the injury or extent of disability. The injured worker–still recovering from an injury–is then left without worker’s compensation coverage. If the employer did not continue health insurance benefits, the worker then takes a double hit–no worker’s compensation covearge and no health coverage. The injured worker then has limited means to obtain the necessary medical treatment.
As an attorney, we have the ability to file for prospective medical treatment and have a judge order the treatment be paid by worker’s compensation. That process, however, could take a year or more.
The best practical route is for the worker to obtain the medical treatment through their own health insurance (and we have a claim for reimbursement to the health insurance company). Thus, if a worker has no health insurance coverage, my advice is: get covered if you can. In Wisconsin, that means applying for state insurance/Medicaid (eligibility based on income levels). The alternative, is ObamaCare.
ObamaCare’s open enrollment period begin a few weeks ago and goes until February 15, 2015. Wisconsin’s governor, Scott Walker, made the short-sighted decision to reject Medicaid expansion or create our own state exchanges, so Wisconsin residents need to obtain ObamaCare insurance on the federal exchanges. If an injured worker has no health insurance, I strongly encourage them to get coverage. Apply for ObamaCare right now. Get covered.