Many people who work in Tennessee also carry their own health insurance. Some people are lucky enough to receive employer sponsored health benefits, while others pay for their entire premium out of pocket. Regardless of whether you pay your own insurance or your employer does, you shouldn’t turn to that insurance if you wind up sick or hurt because of your job.
Tennessee employees who suffer injuries or develop an illness because of their work have the legal right to receive workers’ compensation benefits. These benefits include health coverage specific to the workplace injury or work-related illness.
If you already have health insurance, you may wonder why you would want to bother with filing a workers’ compensation claim for the same coverage. There are actually two very good reasons why workers’ compensation health insurance is a better option than your standard health coverage.
Workers’ compensation coverage pays for everything
The most substantial difference between the average health insurance policy and workers’ compensation health insurance coverage is what you, as the patient, have to bear responsibility for. Your liability under standard health insurance will vary depending on your policy. Many insurance programs require co-pays, deductibles and coinsurance from members.
A deductible is a specific amount of money you will need to pay for your health care before the insurance company will cover anything. Many people have deductibles that are well over $1,000. Even when you meet that deductible, you will still have to cover your co-pay for every appointment. A co-pay is a fixed amount that you have to pay before you even get to your doctor’s visit.
After you pay your co-pay and meet your deductible, you will likely still have to pay coinsurance. Coinsurance is a percentage of your total medical costs that you must cover. Many policies require as much as 30% out-of-pocket by the individual receiving care. Compared with the 0% liability you have for health benefits received through workers compensation, it is obvious which one benefits you more.
Workers’ compensation typically won’t cap your benefits
In the fine print of your medical coverage, you will likely find that there is a maximum amount that your insurance company will pay in a given year, as well as over the life of your policy. For those who suffer severe injuries that require surgery and ongoing care or those with a significant illness like cancer caused by their work, it is all too easy to exceed the maximum coverage offered by a private health insurance policy.
Workers’ compensation typically will not limit what care you can receive in a year based on cost alone. Instead, medical necessity and the correlation of the care to your employment are the primary concerns.