If you are hurt on the job in Virginia, the employer should offer you a panel of physicians from which to choose. The employer is responsible for the payment of your medical treatment as long as you treat with a doctor on the panel. This article discusses whether you should private health insurance after a work injury.

Unfortunately employers do not always follow the law. If your employer denies your claim or refuses to offer you a panel of doctors, then you may treat through your private health insurance. But make sure you consider your private health insurance company’s interest if you decide to accept a Virginia workers compensation settlement. They have a lien against any settlement proceeds.

Things to Consider Before Using Private Health Insurance after a Work Injury in Virginia

Here is a common situation: An employee gets injured at work. Their employer asks them not to file a claim for Virginia workers compensation benefits and to instead treat through private health insurance. Why? The employer doesn’t want the hassle of completing work comp paperwork and wants to keep workers’ comp insurance premiums low. In exchange, the employer allows the employee to work light duty at their regular wage.

A few months later the employee has still not recovered. He is no longer able to perform most of his job responsibilities.

Unhappy with the employee’s performance, the employer fires the injured worker to save money and to hire a new employee. This is a big problem.

Most of us have private health insurance through our employers. You may lose your private health insurance if you are terminated from your job. At that point you have three options:

  • become uninsured;
  • purchase private health insurance through the Affordable Care Act (ACA) exchange; or
  • pay for private health insurance through COBRA. None of these choices is good.

You will have to pay a lot of money to stay insured – money that you don’t have when you are unemployed. Or if you treat without insurance, you may go bankrupt because of high medical costs. That’s why you should pursue workers’ comp right away.

There are other reasons why you should file a work comp claim and pursue treatment through workers’ compensation insurance rather than relying on private health insurance:

  • Most private health insurance plans have deductibles. If your claim is covered under the Virginia Workers’ Compensation Act, you do not have to pay a deductible to get treatment.
  • Most private health insurance companies require that you pay a co-pay when getting care. These co-pays can run from $10 to $100 per appointment. With workers’ compensation insurance you pay no co-pay.
  • Your private health insurance company will not reimburse you for mileage to and from medical appointments and the pharmacy. Workers’ comp will.
  • Your private health insurance company will probably not provide transportation to and from medical appointments. Workers’ comp will.
  • Private health insurance plans do not provide wage loss benefits or payment for permanent partial disability

Can I Use Private Health Insurance if Workers' Comp Denies Coverage and My Case is Pending?

So you followed our advice and filed a claim after your work injury. Your employer and its workers’ compensation insurance company still refuse to provide medical care. Should you use private health insurance to treat until the Virginia Workers’ Compensation Commission makes a decision at hearing?

Yes. You should use your private health insurance if workers’ comp refuses to cover or pay for the treatment you need. But do not settle your case without considering how much your private health insurance company paid on your behalf. They may assert a lien on settlement proceeds. Or they may retract payment if you do not consider their interests. When payment is retracted, the medical provider may sue you for payment for your medical care.

An experienced workers compensation lawyer can tailor the settlement agreement to try to protect you from an aggressive private health insurance company. He can also negotiate with the private health insurer before you enter into a settlement.

The Work Comp Insurer Offer Me a Doctor, But I Don't Like Him. Can I Treat through My Private Health Insurance?

A reader once asked, “Can I see a doctor I like through private health insurance? The workers’ comp panel doctor rushes me in and out of the office and doesn’t listen to my complaints. And I think he does whatever the nurse case manager tells him to do.”

Believe me, we get it. Though the workers’ comp insurer is not supposed to manage medical care under the Virginia Workers’ Compensation Act, they often try to pressure doctors into releasing you back to work too soon. Their goal is to limit the value of your claim and to get you back to work as soon as possible, whether it is in your best interest or not. We understand why you want to pick your own doctor.

Stopping treatment with the panel physician and using a different doctor is risky. The worker’s comp insurance carrier may refuse to pay for treatment from an unauthorized physician, leaving you on the hook for the bill. If you have concerns with how the workers’ comp panel doctor is treating you, contact a Virginia workers compensation attorney to discuss filing a change in treating physician claim. Do not make this decision lightly and on your own.

Looking for advice with your work comp claim? Not sure if you should use private health insurance after a work injury? Call or e-mail us now for a free consultation.