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Why file a workers’ comp claim instead of using personal insurance?

On Behalf of | Nov 10, 2023 | Workers' Compensation |

Workers in Illinois may understand the idea of workers’ compensation coverage, but they may also feel averse to filing a claim. Many employees worry that their claim will cost the business money or potentially harm their reputation at work.

When they need medical treatment, injured workers may try to use their own health insurance as a result of such concerns. Especially if someone develops a job-related health condition, like carpal tunnel syndrome, they may think that seeing their own doctor and using their health coverage makes more sense than filing a workers’ compensation claim. However, there are actually a few very compelling reasons why workers may need to pursue workers’ compensation benefits after an injury or diagnosis of a job-related health challenge.

Health insurance likely won’t cover work injuries

Health insurance policies in Illinois and across the country are very strict about liability matters. In any scenario in which liability insurance should apply, health insurance will typically not cover someone’s treatment costs. If a worker discloses that they got hurt on the job or their physician is able to determine that detail without direct verbal statements, they may include those details in the medical records for someone’s care. Health insurance may then decline to cover treatment costs or may subrogate the claim by trying to hold the employer accountable.

Health insurance makes the patient pay

Most modern health insurance policies have multiple different types of charges that pass to patients. A deductible that someone must pay out of pocket before the insurance will cover their costs is common. There will also often be co-pays for every appointment or medication a patient requires. Finally, there could be coinsurance that makes the patient responsible for a flat percentage of the treatment costs. Unlike health insurance, workers’ compensation does not make the employee cover any of their care expenses. Workers can therefore get exactly what treatment they need without any additional financial hardship.

The worker may require accommodations

The more an injury or condition affects someone’s job performance, the more important it may be to have their employer help them. Companies aware of a worker’s job-related health issue may be more open to providing accommodations while someone has functional limitations. Employers can offer change job responsibilities, provide assistive technology and grant other accommodations that allow a worker to return to work as quickly as possible and avoid worsening their injury. They may be more likely to do so when there is an open workers’ compensation claim.

Although many people worry about filing workers’ compensation claims, doing so is often a smart move. Utilizing workers’ compensation health care coverage may be beneficial for someone dealing with a job-related health challenge for numerous reasons.