Will my health insurance cover me if work comp is denied?
I work at a resturant and this past weekend I slipped and fell on my head. The fall was my fault because 1) I chose to slide on the floor that I knew was wet 2) I was drinking and they know because when I went to the hospital they took my alcohol content. I am going to try and file a Workers Comp claim through the place I work just to get my medical bills paid thats it. I know it doesnt cost the business anything because I talked to a insurance rep and its just included in their insurance. However their insurance can deny me because of the alcohol so if they do will my own insurance cover me? The hospital bill was for $2500 which included a CAT scan and stitches.
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Actually, it DOES cost your employer money (indirectly) because the claim, if allowed, will raise their future WC insurance rates. I suspect your WC claim will be denied because you incurred the injury through misbehavior – not while legitimately performing your job. As for your health insurance, ask them.
You asked this question before and the answer is exactly the same. The Workers Compensation Insurance Company cannot deny coverage on this claim even if you directly contributed to causing your own injury–as long as it was on the job! Your health insurance company will legitimately deny coverage for this claim since you are supposed to be covered by Workers Compensation coverage. In terms of costing the business–they pay for the Workers Compensation Insurance and depending on the number of claims they can have the insurance increased so yes it does cost them something–I don’t know what kind of representative you talked to or how you phrased the question but you were most definitely misinformed.
I suggest you follow the advice I gave you before and follow up with your employer to find out the name of the insurance company, claim number, adjuster name and phone number so that you can speak with them, submit your medical bills, etc.
I write Workers Compensation and Health Insurance so I do know how both types of coverage work.
Good Luck!
health-quotes.isgreat.org – here is my health insurance plan. As I remember they can provide such a service.
Your biggest problem is not the bill, but keeping your job. Once your employer finds out that you were drinking on the job, most likely wont want you around in the future, especially for your lack of thinking by sliding on the floor.
good luck
IF the workers comp policy denies you, then you can force your health insurer to pay for it – BUT you’ll need a copy of that denial letter.
Depending on what state you live in, workers comp will either flat out cover you, or flat out deny you – if you live in a state where being drunk voids your coverage.
The op did not provide the state here… but the answer that the
claim can’t be denied is WRONG>.. WRONG>..WRONG. If there is
alcohol or drugs, or a blatant misuse of company property, the
claim CAN and will be denied…legally. Margarita, if you are going
to post that information…please provide the link to your
authority you are basing the info on. Just because the WC carrier
denies…does not mean your personal health coverage will pick up
the tab. ”Depending on what state you live in, workers comp will
either flat out cover you, or flat out deny you – if you live in a
state where being drunk voids your coverage.” THAT is true…
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