Can I Use My Own Insurance Instead of Workers’ Comp?

A work injury can strike anyone at any time. In 2021, Pennsylvania had approximately 138,400 cases of nonfatal occupational injuries and illnesses across all industries, according to the most recent data published by the Center for Workforce Information and Analysis. The report also reveals that approximately 79,400 cases required workers to miss work days. 

Workers can file a compensation claim to pursue reimbursement or payment for their injury-related medical treatments. But sometimes, the process can be slow or lead to adverse results, such as denials. Workers in this situation may wonder, “Can I use my own insurance instead of workers’ comp?” Workers may be able to use their private health insurance to cover medical expenses that workers’ comp refuses to cover, but doing so may delay or negatively impact their benefits. Further, not all insurance providers will cover work-related injuries that may qualify for workers’ compensation.

At Krasno Krasno & Onwudinjo, we tirelessly fight for injured workers throughout Pennsylvania. We understand how important it is to get the treatment and benefits you deserve so you can get back on your feet and get back to work. Our team of Pennsylvania workers’ compensation lawyers provides unparalleled representation to those in Philadelphia, Pottsville, Pittsburgh, Norristown, and the surrounding areas. 

What Is Workers’ Compensation Insurance?

Workers’ compensation insurance is a special insurance policy that Pennsylvania employers purchase to cover the expenses of a work-related injury suffered by eligible employees. The policy typically does not require employees to prove their employer was at fault to receive benefits such as payment for medical costs and limited wage replacement benefits. But Pennsylvania law does have requirements that employees must follow to receive benefits. 

For example, an employee must file the workers’ compensation claim within 21 to 120 days after they suffer an injury or realize they were injured because of work (such as hand-arm vibration syndrome). Additionally, employees must show that they are covered under their employers’ policies (e.g., by showing they are employees rather than independent contractors). 

Is Workers’ Comp Required in Pennsylvania? 

Under Pennsylvania’s Workers’ Compensation Act, all employers must carry workers’ compensation insurance through an insurance company or by obtaining qualified self-insurance. Regardless of the type of insurance the employer chooses to have, it must meet the minimum requirements under the current rules. Additionally, businesses that elect to carry self-insurance must follow the designated procedure. 

Do I Have to Use Workers’ Comp When I Suffer an On-the-Job Injury in Pennsylvania?

If you suffer an on-the-job injury, you may have concerns about how long workers’ compensation settlements take. After all, you are injured now, so it is crucial for you to get the help you need as quickly as possible. So, do you have to use workers’ comp if you are injured? Technically, you do not have to file a workers’ comp claim if you do not want to. But it’s important to know what it means if you do not exercise your right to do so. 

Workers’ comp covers your medical bills and the lost wages you experience while recovering from your injury. In contrast, your private health insurance company likely only covers your approved medical expenses. Further, some private insurance policies may not cover a condition if it is work-related or potentially covered by workers’ compensation insurance. By electing to use your private insurance policy rather than workers’ comp, you may be subjecting yourself to unnecessary out-of-pocket expenses. For questions about what applies to your specific situation, it’s critical to speak to an experienced attorney in your area before you make any decisions. 

Can I Use My Own Insurance Instead of Workers’ Comp?

You may be able to use your own insurance instead of filing a workers’ compensation claim; however, it may not be the best option in your situation. Further, your private health insurance policy may not cover work-related injuries since these are typically paid for through your employer’s insurance coverage. 

So, by pursuing a private claim instead of using workers’ comp, you may jeopardize your ability to receive compensation through workers’ comp. Additionally, you may incur unnecessary medical expenses that workers’ comp would otherwise cover. For those reasons, using private health insurance may not be advisable or available in your situation. 

Why Can’t I Use My Own Insurance Instead of Workers’ Comp?

Using private health insurance for your work injury may sound convenient, but it may not bring about the result you deserve or are expecting. There are some important differences between private health insurance and workers’ compensation insurance. Workers’ compensation insurance provides comprehensive benefits to reimburse you or outright pay for the cost of your injury-related medical expenses. Further, workers’ comp insurance offers you benefits such as lost wages and physical therapy. 

In contrast, your private health insurance policy only covers select medical procedures. Moreover, many health insurance companies may deny coverage for work injuries covered under a workers’ compensation policy, regardless of whether the employee chooses to pursue workers’ comp benefits. 

For those reasons, the safest bet is to file a workers’ comp claim to pursue the benefits you may be entitled to under Pennsylvania law. Anytime you visit the doctor or another healthcare facility for your work-related injury, inform the medical staff that you suffered an on-the-job accident. They can include this in the medical record to help support your claim for benefits. 

What Can I Do if Workers’ Comp Refuses to Cover My Medical Treatment?

If workers’ comp refuses to cover your medical treatment for your work-related injury, you can file an appeal with the Pennsylvania Workers’ Compensation Appeal Board. To file an appeal, you prepare and submit a petition presenting the legal arguments in favor of your receiving benefits. A Pennsylvania workers’ compensation lawyer can help you draft and file this critical document. 

Some people may be tempted to use their private insurance, such as Blue Cross Blue Shield, to cover a work-related injury when they receive a denial. The best practice is to talk to a workers’ compensation insurance lawyer before making this decision. If you have a valid claim for workers’ comp benefits, filing a claim with your private insurance provider may complicate or undermine the strength of your case. The lawyer can help you determine the proper course of action under your unique circumstances. 

Does Private Health Insurance Cover Work-Related Injuries After the Settlement?

If you win your workers’ compensation claim, you may receive a settlement to cover your medical bills, lost wages, and other covered losses because of your work injury. Once your case concludes, your private insurance company may cover the cost of treating the work-related injury. That said, it depends on the terms of the settlement and your specific insurance policy. Furthermore, your private insurance may not cover future injuries or on-the-job accidents that worsen your existing work injury. 

Contact a Workers’ Compensation Attorney at Krasno Krasno & Onwudinjo

Like Pennsylvania, our roots run deep. Founded in 1936, Krasno Krasno & Onwudinjo is a steadfast force for workers’ rights throughout Pennsylvania. Our sole focus is helping injured firefighters, teachers, manufacturing workers, and other workers navigate the complex and often confusing process of applying for and receiving benefits. We believe workers should have the peace of mind to focus on their physical recovery while our team takes care of legal matters. Our team includes Andrew Onwudinjo, who has been practicing workers’ compensation law for over 30 years. 

If you suffered a work injury in Pennsylvania, contact our team today by calling 844-243-4843 or using our online contact form. Consultations are free.

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