Key Takeaways
- In Virginia, workers' compensation is the correct coverage for work-related injuries—not your personal health insurance.
- Employers who pressure injured workers to use their private health insurance rather than file a workers' comp claim may be trying to avoid a reportable claim, and doing so can seriously damage an injured worker's ability to recover full benefits.
- A Virginia workers' compensation lawyer can help you correct course if this has happened to you.
When you are injured at work, you may assume that your employer will simply direct you to the nearest clinic and handle the paperwork. But some injured workers in Virginia are told something unexpected: "Just use your health insurance," or "We'd rather keep this off workers' comp."
If that has happened to you, it is important to understand why following that advice can put your medical and financial recovery at risk. The Virginia workers' compensation lawyers at Dulaney, Lauer & Thomas have helped many injured workers in similar situations. Know your rights to workers’ comp in Virginia after an employer asks you to use health insurance for a work injury.
What Does Virginia Workers' Comp Law Say About Medical Coverage?
Under Virginia workers' compensation law, if your employer has three or more employees, it must carry workers' compensation insurance. That coverage should pay all of your medical expenses related to a qualifying work injury—not two-thirds, not a portion, but the full amount. This is one of the core protections of the Virginia workers' comp system. Our overview of Virginia workers' compensation rights explains this in more detail.
Your personal health insurance, by contrast, is designed to cover non-occupational illness and injury. When you use your health insurance for a work injury, you are typically responsible for your deductible, copays, and coinsurance. These are costs you would not owe if the claim were properly handled through workers' comp.
Can Your Employer Legally Require You to Use Your Health Insurance?
No. Your employer does not have the legal authority to require you to use your personal health insurance in place of workers' compensation for a qualifying work-related injury. If your employer is telling you otherwise, they may be attempting to avoid filing a First Report of Injury form with the Virginia Workers' Compensation Commission, which is required within 10 days of receiving notice of a work injury.
Employers have financial incentives to keep claims off the books. A workers' comp claim can affect their experience modification rate, which in turn affects their insurance premiums. But that employer motivation does not override your legal rights as an injured worker.
What Are the Risks of Using Your Health Insurance for a Work Injury?
Using your personal health insurance after a work injury creates several problems, some of which can be difficult to reverse:
- Out-of-pocket costs. You absorb deductibles, copays, and coinsurance that workers' comp would have covered entirely.
- Lost wage benefits. Filing through health insurance rather than workers' comp means you are likely not filing a workers' comp claim at all. So, if you miss work, you may lose access to the wage replacement benefits that workers' comp provides.
- Weaker claim position. A delayed or absent workers' comp claim gives the insurer grounds to argue that your injury was not work-related, that it was not serious, or that it arose from a preexisting condition.
- Statute of limitations risk. In Virginia, you generally have two years to file a claim with the VWCC. If time passes while you are using health insurance and you later realize the claim should have gone through workers' comp, that deadline may be closing.
As discussed in our article on when to call a workers' compensation lawyer in Virginia, any delay in filing your claim can be used against you by the insurer. The practical effect of using health insurance instead of workers' comp is that you hand the insurer that argument on a silver platter.
What About the Workers' Comp Authorized Physician Requirement?
Virginia workers' comp law requires that you receive treatment from a physician who is authorized by your employer's insurance carrier, at least initially. This is a different question from whether workers' comp or your health insurance covers the payment.
If your employer told you to see your own doctor and bill your personal insurance, you may have received treatment from a provider who is not on the approved list, which can create additional disputes about whether the insurer must reimburse those expenses. Our FAQ on what Virginia workers' compensation covers explains the requirements for an authorized provider.
What If You've Already Used Your Health Insurance?
If you have already used your personal health insurance for what you now believe is a compensable work injury, you may not be out of options—but time matters. Here is what to consider:
- File a claim with the VWCC as soon as possible using the Claim for Benefits Form available on the VWCC website. The statute of limitations clock is running.
- Notify your employer in writing that you are treating the injury as a work-related claim subject to workers' comp coverage.
- Consult a workers' comp attorney. An attorney may be able to help you seek reimbursement for out-of-pocket expenses you paid that workers' comp should have covered.
Our article on Virginia workers' compensation law covers the claims process, steps for filing, and what happens after a claim is submitted.
How Does This Affect Your Health Insurance Provider?
There is one more complication to be aware of. If your health insurance pays medical bills that workers' comp should have covered, your health insurer may have a right to seek reimbursement (sometimes called subrogation) once a workers' comp claim is established. That means money you receive through workers' comp may be subject to a lien from your health insurer. A workers' comp attorney can help you protect as much of your recovery as possible.
The workers' comp attorneys at Dulaney, Lauer & Thomas serve injured workers in Warrenton, Front Royal, Culpeper, and throughout Virginia. If your employer has told you to use your own health insurance for a work injury, we’re here to help secure you the benefits you deserve.