Workers’ compensation generally does not affect your health insurance, as they are two completely different systems. Workers’ compensation should cover all medical expenses related to your work injury, while your health insurance should cover other medical needs during the same period.
If you want assistance with a workers’ comp claim or have questions about what workers’ comp pays for versus what your health insurance should cover, an Orlando workers’ compensation lawyer from our firm can help you.
What Medical Expenses Does Workers’ Compensation Cover?
Workers’ compensation is a no-fault insurance system that offers benefits to employees who suffer work-related illnesses or injuries. Your employer’s workers’ comp policy should cover all medical expenses related to the harm you suffered on the job, including:
- Ambulance rides
- Emergency room care
- Hospital stays
- Doctor’s visits
- Medical tests, such as X-rays, MRIs, and CT scans
- Physical therapy
- Rehabilitation
- Prescription medications
- Medical equipment, such as crutches, wheelchairs, or prosthetic devices
- Travel expenses related to medical appointments
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What Medical Expenses Does Health Insurance Cover?
Workers’ compensation does not cover any medical needs that are unrelated to your work injury. For example:
- If you fall down a flight of stairs in your apartment complex and break your leg, your health insurance should cover treatment related to your leg injury. Workers’ comp will not cover this expense because the injury is not work-related.
- If you come down with the flu while recovering from your work injury, your health insurance should cover any antiviral medications and other treatment you may need to overcome your illness.
- If you need an annual checkup or routine medical test (such as a mammogram or colonoscopy) while receiving workers’ comp benefits, your health insurance should cover these tests.
Who Pays for My Health Insurance While I’m on Workers’ Comp?
If you continue working while on workers’ comp (such as if you have a partial disability and can still perform limited work while recovering), your employer-sponsored health insurance should continue as normal. You will likely need to continue paying the portion of your health insurance premium that you typically cover, and your employer will cover any portion they normally cover.
If you have a temporary total disability (TTD) and cannot work at all while you recover, your employer may keep you on their plan, or you may need to pay your full health insurance premium until you recover enough to return to your job and start getting a paycheck again. If you fail to make these payments, your health insurance provider may cancel your policy.
What Happens if I Lose My Job?
Per Florida Statutes § 440.205, your employer cannot fire you because you filed a workers’ comp claim. However, they are also not legally required to hold your job for you while you recover.
If your employer terminates your employment while you’re on workers’ comp, you may lose your employer-sponsored insurance plan. In that case, you may need to find another option for health insurance, such as COBRA or a private health insurance policy.
If you’re unsure what will happen to your health insurance coverage while you’re away from work due to an injury, you can ask your employer or a workers’ compensation attorney.
Other Benefits Available Through Workers’ Comp
In addition to medical benefits, workers’ comp also offers wage replacement benefits. According to the Florida Department of Financial Services, workers’ comp generally covers up to two-thirds of your average weekly wages up to a maximum of $1,295 per week (as of 2025).
Workers’ comp also offers death benefits to the families of employees who pass away due to work-related injuries or illnesses. Per Florida Statutes § 440.16, surviving family members may qualify to receive:
- Reasonable funeral and burial expenses (up to $7,500)
- A portion of the deceased worker’s average weekly wages
- Educational expenses associated with a surviving spouse’s job training
Can I Sue My Boss After a Work-Related Illness or Injury?
The workers’ comp system allows you to file an insurance claim regardless of who is at fault for a work accident. Because workers have this protection, you generally cannot sue your employer after a work injury in Florida.
However, if someone other than your employer caused your injuries (such as a subcontractor, delivery driver, or the manufacturer of a dangerous product), you may qualify for a third-party personal injury lawsuit. In that case, you could recover damages that are unavailable in a workers’ comp claim, such as:
- 100% of your lost wages and benefits
- Diminished earning capacity
- Pain and suffering and other non-economic damages
An Orlando personal injury lawyer from our office can evaluate your case and determine whether you qualify to sue one or more liable parties for your injuries.
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Tips for Maximizing Your Workers’ Comp Benefits
To ensure you get the most out of the workers’ comp insurance system, we recommend that you:
- Report your work-related illness or injury to your employer immediately.
- Seek medical treatment as soon as possible from a doctor approved by your employer, and inform the doctor that you will be filing a workers’ comp claim.
- Follow your doctor’s instructions carefully and don’t skip any medical appointments.
- Keep copies of all medical records and any correspondence with your employer regarding your injury or illness.
- Consider hiring a workers’ comp lawyer to help you throughout the process.
What Should I Do if the Insurance Company Denies My Workers’ Comp Claim?
Insurance companies may deny workers’ compensation claims for several reasons, such as:
- Your injury is pre-existing or is not related to your job.
- You did not provide enough evidence of your injury.
- Your paperwork is missing required information or contains errors.
- The insurance adjuster suspects fraud.
If you believe your claim is valid but the insurance company fights back, you have the right to file an appeal. We strongly recommend hiring a workers’ comp attorney to assist you through the appeals process, as it involves several complex legal steps.
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At Bogin, Munns & Munns, we have served injury victims in Central Florida for over 40 years, and we treat our clients like members of our family. If you have questions about the differences between workers’ compensation and health insurance, or if you want help with your workers’ comp claim, we are here for you. Contact us today for a free initial consultation.
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