Hi. I assume workers compensation is primary to health insurance. In a state like Montana where WC is optional for a sole proprietor, if the proprietor elects not to buy WC, will the health insurance typically cover on-the-job accidents? Thank you.
For a sole proprietor who doesn’t have other employees, I’m not sure how a WC policy will benefit them.
WC covers an exposure where the employer has strict liability for injuries to its employees due to illness or injury sustained while “on the job”. I do believe that this strict liability is why WC is associated with P&C rather than Life/Health.
So I would expect that a health insurance policy will cover medically related things. What might not be covered that a WC policy might is lost wages.
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Vorian, thanks for your reply.
The sole proprietor has his own risk of injury, so that is why a WC policy would benefit him. Let’s ignore wage loss. I believe health insurance commonly excludes injuries that are supposed to be covered under WC. So if the sole proprietor has the option of WC and declines it, does this health insurance policy step in, or does the health insurance policy still exclude coverage?
You would have to check the specific policy language, but it would be a major coverage gap if the health insurance did not kick-in in that instance.
For example, here is the exclusion clause from a BCBS Montana Silver Policy:
This Exclusion will not apply if the Member’s employer was not required and did not elect to be covered under any Workers’ Compensation, occupational disease laws or employer’s liability acts of any state, country, or the United States.
So the policy will cover work-related injuries since WC was not required.
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i have seen it covered by the health insurer, but a stop loss writer (excess on the self funded employee plan) try to exclude such claims if they go past the attachment point.
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Thanks, examsarehard.
It’s funny that WC is CAS vs SOA to me and I cannot opine on it with my letters.
you can. you can gain the necessary experience by working under supervision of another qualified actuary for some period of time and then your credential can cross the aisle.
I have actually filed a workman’s claim comp before for neck pain (staring at a computer monitor too long). I have high copays so seeing a physical therapist would have cost me $50 a visit, and at 2-3 visits a week for 8 weeks that could be a thousand bucks!!!
I filed a workman’s claim comp and had to go see a specific workman’s comp physical therapist but it was all covered by my workman’s comp plan. My company also gave me extra paid time off to go to my PT sessions
After 8 weeks my neck still hurt so my company gave me the option for surgical consult or a $4000 check
Easiest $4k I’ve ever made in my life
Anyways I doubt your health insurance company will know that your injury is work related unless you go to a specialized workman’s comp clinic or you tell your providers
I would probably forgo the workman’s comp coverage unless you have some serious propensity to hurting yourself on the job
As for me I just file “bogus” claims everywhere and hope something sticks (it usually does)
Wheels turning!!!
Just to get discounts on my 36 visits to the chiro vs the 20 that were approved.
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Very easy to finagle for hand/wrist or neck pain or anything sort of injury associated with sitting at a computer desk for 8 hours a day
I’ll give it a try. See what happens
I don’t think anything is going to happen with my work comp claim. A little worried about the drug test. 10mg THC last weekend. Uh oh.
You should be fine if it’s just a piss test
The usual advice applies - exercise, don’t provide them with your first piss of the day (pee into your own toilet when you wake up), chug water, and b vitamins