In New York, maintaining your health insurance coverage while on workers’ compensation depends on several factors, including your employment status, the nature of your leave, and your employer’s policies.
Accepted Workers’ Compensation Claim:
- Leave Without Pay (LWOP): If your workers’ compensation claim is accepted and you’re on LWOP due to a work-related injury or illness, you’re eligible to continue your health insurance coverage. However, you must pay both the employer’s and the employee’s share of the premium (100% of the cost).
Controverted (Disputed) Workers’ Compensation Claim:
- LWOP Status: In cases where your claim is disputed, you can still maintain your health insurance while on LWOP, but you’re responsible for the full premium cost, covering both the employer’s and employee’s portions.
Waiver of Premium:
- Total Disability: If you’re totally disabled for at least six biweekly pay periods, you may qualify for a waiver of the medical insurance premium while on LWOP, provided you’re enrolled in the Empire Plan. This waiver isn’t automatic; you must apply for it and continue paying premiums until approval. If granted, the waiver exempts you from premium payments for up to 12 months or until you return to payroll or your employment ends, whichever occurs first. Note that Health Maintenance Organization (HMO) enrollees aren’t eligible for this waiver.
Employer’s Rights and Responsibilities:
- Job Security: While employers cannot retaliate against you for filing a workers’ compensation claim, New York is an at-will employment state. This means employers aren’t obligated to hold your position open indefinitely if you’re unable to work due to injury, especially if business needs require filling the role. However, they cannot terminate your employment solely because you’ve filed a workers’ compensation claim.
Family and Medical Leave Act (FMLA):
- Health Insurance Maintenance: If you’re eligible for FMLA leave, your employer is required to maintain your health insurance benefits during the 12-week leave period under the same conditions as if you were actively working.
Conclusion:
To ensure continuous health insurance coverage during your workers’ compensation leave, it’s crucial to communicate proactively with your employer’s human resources department. They can provide specific information about premium payments, potential waivers, and any other benefits you may be entitled to during this period.