WorkComp Advisory
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Health care coverage and Workers’ Compensation leave

The following information is provided by our strategic partner, HR That Works!

Many employers are confused about their obligation to continue health care coverage when someone is out on extended Workers' Comp leave. Here are some general guidelines to consider:

  • Workers’ Comp law doesn't require an employer to keep paying an employee's health care when they're on extended leave due to a Workers’ Comp injury. An employer may not discriminate against someone on Workers’ Comp leave. For example, if your practice is to continue health care coverage for two or three months hoping that someone can return to work, you need to maintain this practice with an employee on Workers’ Comp leave or face a discrimination or retaliation claim.

  • Be aware of a health insurance provision that employees must be "actively employed." For example, if they haven't worked for two months, they may not be actively employed. Even though you might have extended their coverage, if they have a significant claim, the carrier may decide to decline coverage, leaving them unprotected because you didn't issue them a COBRA notice. Not a good spot to be in.

  • Remember, if you have more than 50 employees, the FMLA requires you to maintain extended coverage for at least 12 weeks — but only if there's a reason to believe the employee will be returning to work.

Note: Many employers have FMLA run concurrently with Workers’ Compensation. When employees are injured, they are not only given information about Workers’ Compensation and transitional duty, they are also given notice of their entitlement to leave under FMLA. If an employee is able to perform transitional duty, but does not want to accept the position, they have the option of taking unpaid leave under FMLA.