It is not uncommon for employees to be injured while working. When this happens, you may wonder if using your health insurance after a workplace injury instead of workers’ compensation insurance could be more logical and practical.

However, if workers’ compensation insurance is available, it is best to take advantage of it in most situations.

If you have questions about how workers’ compensation insurance works with private health insurance coverage and state laws, the Matt Fendon Legal Group attorneys can help. We’ll break down your options and decide which is the right one for you. You can call us at any time at (800) 229-3880 to speak with an Arizona workers’ compensation insurance expert and to make an appointment to review your case in an initial consultation.

What is the Difference Between Workers’ Compensation and Private Health Insurance?

Arizona is one of the many states that require employers to carry workers’ compensation insurance in case of an accident with their employees. Outside of this sporadic requirement, workers’ compensation insurance and private health insurance have one thing in common: both can pay for your medical bills after an injury on the job.

However, workers’ compensation does much more than just pay for your medical expenses. Workers compensation insurance provides the following resources:

• At least partial lost wage benefits for lost income when you cannot work
• Disability benefits if you are permanently or temporarily disabled
• Funeral costs and burial expenses if a worker dies because of a work-related accident or medical condition
• Survivor benefits in the event the injured worker dies on the job

These coverage areas are key factors that make the workers’ compensation system more than just a healthcare insurance policy. When workers need help getting back on their feet after a work accident, they typically turn to their employer’s workers’ compensation policy first.

Other important differences between private healthcare insurance and workers compensation policies include:

• You can’t lose workers’ compensation coverage because of a job loss or an inability to pay insurance premiums
• You pay no co-pays, deductibles, or other out-of-pocket costs to use workers’ comp
• You are not subject to insurance coverage limits with workers’ compensation for a work-related injury

Does Private Health Insurance Cover Work-Related Injuries?

The general answer to whether your private health insurer will pay for medical treatment after a workplace injury is, “Probably not.” There are a couple of main reasons for this.

First, many health insurers will simply refuse to cover medical treatment that should be covered by workers’ comp Instead, they will defer to the workers’ compensation insurance company to pay those costs.

Second, even if they initially agree to pay for your medical care costs after a work accident, many workman’s comp insurance companies will seek to pass those costs on to your workers’ compensation insurance anyway. An even worse scenario could involve your private insurance company initially agreeing to cover the cost but denying the coverage later and seeking reimbursement from you.

In short, you shouldn’t rely on private health insurance as your primary coverage for work-related injuries. If possible, turn to your employer’s insurance policy first.

Why Do Employees Try to Use Private Insurance When Workers’ Comp is Available?

An injured worker might initially decline to use workers’ comp coverage for several reasons. These are frequently based on well-meaning but ultimately misguided efforts to save time and money.

For example, an employee might seek to use private insurance coverage to avoid the time it takes to report the claim and go through the process of receiving workers’ comp benefits. This is particularly prevalent if the employee receives a seemingly minor injury. 

On other occasions, many small business owners might ask you not to report your injury to workers’ comp by claiming they will cover your medical expenses instead. This occurs when the business owner is afraid of seeing their workers’ compensation premiums go up.

However, trouble can arise if your treatment costs exceed your employer’s cash flow and ability to pay. This is especially troublesome if you’ve reported your injury to the workers’ comp insurance provider after their policy expires.

Lastly, workers may be reluctant to report workplace accidents because of fears that doing so will jeopardize that person’s continued employment.

None of these are good reasons to forgo using your workers’ compensation benefits. You are almost always better off relying on workers’ comp than your personal insurance.

What if Workers’ Compensation Insurance Denies Coverage?

The one exception to not relying on workers’ compensation to cover your injury is if your claim is denied. 

In these cases, you and your workers’ compensation insurance lawyer can appeal the coverage denial by workers’ comp. During this interval, you may need to resort to your personal health insurance to address healthcare costs.

If this happens, let your health insurer know that you have sought workers’ compensation insurance coverage but have been at least temporarily denied coverage. At the same time, it is good practice to appeal the initial denial to the Industrial Commission of Arizona.

If your workers’ comp claim is denied, you will have 90 days to file a request for a hearing by completing and submitting a hearing request form to the ICA. You can also write a letter to the ICA requesting a hearing, after which the ICA will set the date and time for your hearing.

If your workers’ comp claim has been denied, contact Matt Fendon Law Group immediately to discuss your legal rights.

It is important to track how much your private insurer pays for your treatment during your appeals process. This amount can be recovered later if you reach a settlement agreement with the workers’ compensation insurance company.

An experienced workers’ compensation lawyer, the ones at Matt Fendon Law Group, can help you negotiate such settlement agreements.

Talk With an Arizona Workers’ Compensation Law Firm Today

Even if your employer is required under Arizona law to buy workers’ compensation insurance, problems can still arise when you need to make a claim. Appealing a workers’ comp claim denial can be challenging, and relying on private insurance during these periods can be stressful.

Fortunately, you do not have to go it alone when this happens.

At the Matt Fendon Law Group, our highly skilled and compassionate workers’ compensation lawyers are ready to help you with all aspects of your workers’ compensation claim. 

We can help you:

• Understand what is happening with your claim. The process of obtaining workers’ compensation benefits can be stressful and complicated. It’s critical that you have an experienced Arizona workers’ comp lawyer on your side.
• Deal with your employer. Employers sometimes try to intimidate or take advantage of injured workers by trying to get them not to file a workers’ comp claim. The attorneys at Matt Fendon Law Group will stand up for your rights.
• Negotiate with the insurance carrier. Workers’ comp insurance companies are less likely to give you the run-around when you have a skilled and aggressive attorney in your corner. This makes it less likely that you will need to use a private health insurer.
• Receive the compensation you deserve. While you recover from your work injury, workers’ compensation benefits pay a portion of your lost wages and medical bills. Our attorneys will fight to get you the benefits you need and deserve and ensure that any workers’ comp settlement accounts for any private health insurance amounts spent if your workers’ comp claim is initially denied.

Call us today at (800) 229-3880 to schedule a confidential, free consultation with an experienced workers’ compensation lawyer in Phoenix.

Or, if you prefer, you can contact us online to ask a question or to schedule a free consultation.

We have offices in Phoenix, Prescott, Flagstaff, Scottsdale, and Tucson. Let us show you how we can help you with your Phoenix workers’ comp case. We will provide straightforward advice and help you understand your legal options.