Who Pays for Health Insurance While on Workers’ Compensation?

If you are receiving workers’ compensation in California and remain employed, your employer should continue paying their portion of your health insurance premiums. However, you are still responsible for your share of the cost. Since you may not be receiving a regular paycheck, you may need to pay your portion directly to maintain coverage. If your employment ends or benefits are terminated, you may need to seek continuation coverage through COBRA or Cal-COBRA.

Here is how health insurance is typically handled while you are out of work due to a job-related injury.

Workers’ Compensation Only Covers Your Injury-Related Medical Care

Workers’ compensation pays for medical treatment directly related to your workplace injury or illness. This includes doctors’ visits, hospital stays, surgery, medication, and other approved treatments. It does not replace your regular health insurance or cover unrelated medical care.

Your health insurance coverage while on workers’ compensation depends on your employment status and your employer’s benefits policy.

If You Remain Employed

If you are still considered an active employee while out on workers’ compensation, your employer should continue paying their share of your health insurance premiums. However, without a regular paycheck, your portion will not be automatically deducted. You are responsible for making your contributions directly to keep your coverage active.

You should:

• Contact your HR or benefits department right away
• Confirm whether your coverage continues during your absence
• Ask how and when to pay your share of the premium

Failing to make timely payments could result in a lapse in coverage, even if your employer continues to pay their portion.

If Your Employment Ends

If your employer terminates your employment or discontinues your benefits, your group health insurance coverage will usually end. In this case, you may have the option to continue your coverage through:

COBRA

• Applies to employers with 20 or more employees
• Allows continuation of your group health plan for up to 18 or 36 months
• You must pay the full premium (your share and the employer’s) plus a small administrative fee

Cal-COBRA

• Applies to California employers with 2 to 19 employees
• Extends COBRA-like benefits to workers in smaller companies
• Also requires full premium payment

Both COBRA and Cal-COBRA can be costly, but they allow you to keep the same coverage while you are out of work and recovering.

Can Workers’ Compensation Pay for Health Insurance Premiums?

No. Workers’ compensation does not pay for your health insurance premiums. It only covers medical expenses related to your work injury and provides wage replacement through temporary disability payments. These payments are typically two-thirds of your average weekly wage, up to a state maximum, and may not fully cover your living expenses.

You may choose to use your temporary disability payments to help cover your portion of the health insurance premium, but that decision is up to you.

What to Do to Protect Your Coverage

• Notify your HR department as soon as you go out on workers’ compensation
• Ask for written confirmation of your health insurance status
• Keep records of payments you make toward your premiums
• If your job ends, review your COBRA or Cal-COBRA options immediately
• Stay on top of due dates to avoid losing coverage

Talk to a Workers’ Compensation Attorney

Workers’ compensation protects your right to medical care and partial wage replacement, but it does not guarantee continued health insurance coverage. If your employer stops your benefits, or you are unsure how to maintain your coverage while recovering, speaking with an attorney can help.

At the Law Offices of Norman J. Homen, we assist injured workers across California with navigating the workers’ compensation system and understanding how it affects their broader benefits. With offices in Garden Grove, El Monte, and San Jose, we are here to help.

Call today to schedule a free consultation. We will take the time to listen and provide guidance based on your specific situation.