Private Health Insurance vs. Workers’ Comp Insurance

If an injured worker has private health insurance and they get injured at work, should they use their personal insurance or workers’ comp coverage?  Not everyone has this option, so of course, if you don’t have private insurance, Workers’ Comp is the only option.  The issue usually arises more with white collar workers.  Many white collar workers don’t even realize they have an option to use anything but their private insurance and it never comes up.  Employers would much rather an injured worker use their private insurance to keep their Workers’ Comp Insurance premiums low.  Below are the things to consider when trying to decide.  Or just watch my video for an explanation and my recommendations.

Tips on Which Insurance to Use

With private health insurance you can usually go to the doctor you want to use, so long as they are in your plan’s network.  You will get treatment more quickly and most of the time there will be little push back.  Sometimes private insurance will question treatments and you may have to fight with them for payment.  Also, with most private insurance you will have to pay an annual deductible.  This means you may have to pay money out of your pocket for your treatment until the deductible is met.  If your doctor takes you off work, your health insurance won’t cover payments for your lost pay.

With Workers’ Compensation Insurance, you will probably be sent to a doctor of your employee’s choosing initially.  This is not always bad, but often times the employer’s doctors will lean towards opinions favorable to your employer.  You can elect a doctor of your choosing in workers’ comp, but your employer can challenge their findings and make you go to a different doctor for evaluation.  This is called an Employer’s Medical Evaluation.  Also, all treatments through workers’ compensation require pre-approval from the insurance company.  This can cause delays in treatment.  At Rundlett Law Firm, we will always fight delays and denials of treatment in a workers’ comp case.  If your doctor takes you off work due to an injury, and you have a comp claim, workers’ comp insurance should pay you temporary benefits to partially cover that lost pay while you are off.  The best thing about using comp as opposed to private insurance, is that you should not have to pay anything out of pocket for your treatments.  Work comp insurance even has to pay for your mileage driving to and from treatments.

Final Considerations

Whether you use private insurance or workers’ comp insurance for a work related injury, you should always notify your employer of the injury and make a record of the notification.  There are statutes of limitations for workers’ comp claims.  Generally, if workers’ comp has paid nothing towards a claim you are forever barred from making a claim after two years from the date of injury.  If workers’ comp pays some and then stops, you are forever barred from filing the proper paperwork to secure your claim after one year from the date of last payment.  Also, if private insurance is used initially and later you decide to file on workers’ comp, workers’ comp probably won’t reimburse previous payments if they were not approved.  There are lots of pitfalls with this decision, so consider talking to a qualified workers’ compensation attorney as soon as possible after a work injury.


“Success is not final, failure is not fatal; it is the courage to continue that counts.” – Winston Churchill