Many clients ask me what happens to their employee health insurance coverage while they’re receiving workers’ compensation benefits. It’s a great question. Because the answer is complicated, you need to pay close attention to the words written on this page.
In some cases health insurance will continue to be provided. However, you need to make sure you understand your coverage. It may even require you to read this article more than once.
If you have any questions about it, make sure you speak to a personal injury attorney who specializes in workers’ compensation here in Boston.
Let’s dig in.
The Workers’ Comp Law in Massachusetts
The law is very clear on one thing: you cannot face any retaliation just because you filed a worker’s comp claim.
Having said that, it does not offer protection for your health coverage. An employer is within their right to cancel your insurance. However, there are several laws at the state and federal level that can offer you some reprieve.
Protections Under State Law
If you lose your job because you’re no longer able to work, Massachusetts state law provides some protection. In most cases, health coverage must continue for 31 days following termination.
Massachusetts also requires most employers to offer continued coverage under the medical plan for an additional 39 weeks, though the employee can be required to pay the entire premium.
You’ll read about COBRA coverage under federal law below, but Massachusetts has a state law, referred to as “mini-COBRA,” that applies to small-group health plans issued to employers with 2-19 employees.
COBRA generally applies to group health plans offered by employers with 20 or more employees, so mini-COBRA is designed to protect employees of small businesses. Mini-COBRA generally provides the same kind of coverage for the same length of time as COBRA.
Federal Laws That May Help You: The Family and Medical Leave Act (FMLA)
Some people with significant injuries can get legal protection under the FMLA. You can take up to 12 weeks of leave, during which your job and your medical coverage are legally protected.
However, as with all federal laws, there is some small print you must be aware of.
Only organizations with 50 or more employees within a 75-mile radius are required to follow the FMLA. And to qualify, you have to have worked for the company for the last 12 months or at least 1,250 hours.
As I mentioned above, the answer to this frequently posed question is complicated but important. If you haven’t found the answer you’re looking for yet, then keep reading. I promise to keep it light and to the point.
Continue on Your Employer’s Health Plan with COBRA Health Coverage Continuation
Here’s how it works.
COBRA allows you to stay on your employer’s health plan for up to 18 months after you’ve lost your job, and disability can extend this coverage for up to 29 months.
In addition, certain qualifying events may allow you to receive up to 36 months of COBRA coverage. These time periods are only the minimum amount set out by COBRA regulations; your employer’s plan may provide for longer coverage beyond the minimum.
However, the bad news is you have to pay for the health coverage yourself. Still, this is often much cheaper than buying it in the general market. And remember, if you receive workers’ comp benefits, this will cover almost all of your medical expenses related to your injury.
Therefore, the additional health coverage is in case anything outside of the workplace injury happens to you or perhaps your family.
It is important to note that COBRA coverage is different from the coverage provided under the FMLA, and taking FMLA leave is not a qualifying event under COBRA. If you take FMLA leave and fail to return to work after 12 weeks, resulting in a loss of health coverage, COBRA may then be triggered.
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Another Option for You…
If you find that you’re in a position in which you can’t work for over a year because of your injury, then you may want to apply for Social Security Disability Insurance (SSDI).
If you qualify for SSDI, you will be eligible for Medicare, but you have to receive SSDI benefits for two years first. Until you’re enrolled in Medicare, you can apply for MassHealth, which is Massachusetts’ Medicaid program.
In addition to SSDI, you may also qualify for supplemental security income (SSI). If you qualify for SSI, you are automatically eligible for MassHealth. It’s possible to get both Medicare and Medicaid.
With your existing condition covered due to the injury at work, applying for SSDI is sometimes the best option.
Hire the Right Lawyer by Looking for This One Thing
I’m about to hand you the secret sauce that’s going to give you the best possible outcome.
You may already know that hiring a lawyer to handle these problems is the key to getting what you want. However, there are specific things you need to look for so you can hire the best attorney possible. One who is so good a simple phone call could solve your problems. There are no guarantees, but your chances of success will be greatly improved.
Look for online reviews. Did you know that until recently it was illegal for attorneys to collect testimonials and reviews?
The bad lawyers didn’t want the rest of the world to know that they weren’t good at their jobs, especially when it comes to workers’ comp. They lobbied the bar associations to keep their client feedback under wraps.
However, this changed a couple of years ago, and now you can actively see what their clients think of them.
Even better, call them up and ask them for a video interview or something similar from a past client. The most successful attorneys always have clients who are so ecstatic they would leap at the chance of doing a video testimonial or interview.
Once you get the reviews, video interviews, and testimonials you asked for, make sure they are specifically related to workers’ comp; not just general ”personal injury” but work-related injuries.
There are many lawyers out there who try and take on every single case that comes their way without having experience in that specialty area.
In Summary
I told you it was a complicated answer. Everyone’s situation is different, and the laws are immensely complex. Speaking to a personal injury attorney who specializes in worker’s comp in Boston is definitely your best bet.
Here’s a quick summary of the information provided in this article:
- There are laws in the state of Massachusetts that help you keep your health insurance for a certain length of time after you lose your job.
- You can get up to 12 weeks of protection from a federal law called FMLA, but only if your employer has more than 50 employees in a 75-mile radius, along with some other caveats.
- COBRA allows you to retain your group plan for up to 18 to 36 months, depending on the circumstances, but you have to pay the premiums (often cheaper than market rates).
- A long-term injury that keeps you from working could qualify you for Social Security Disability Insurance (SSDI).
