Workers' Comp Loss: A Qualifying Event?

Losing workers' compensation insurance is considered a qualifying event. This means that if you lose your job-based health insurance coverage, you are eligible to enroll in a new health insurance plan outside of the annual Open Enrollment Period. This is known as a Special Enrollment Period (SEP).

During an SEP, you typically have a window of 30 to 60 days before or after the qualifying event to make changes to your health insurance plan or sign up for a new one. It's important to note that the timeframe may vary depending on your state and specific circumstances.

In addition to losing job-based coverage, other examples of qualifying life events include getting married, having a baby, adopting a child, experiencing a change in income, and gaining membership in a federally recognized tribe.

Losing workers' compensation insurance due to job loss

Losing your job-based health insurance is considered a qualifying life event, which means that you are eligible to enroll in health insurance outside of the annual Open Enrollment Period. This is known as a Special Enrollment Period (SEP).

If you lose your job-based health insurance, you have two main options:

• Enroll in a plan through the Health Insurance Marketplace.
• Sign up for COBRA coverage.

If you leave your job for any reason (even if you quit or get fired) and lose your job-based health insurance, you can enroll in a Marketplace plan. You will qualify for a Special Enrollment Period to get coverage for the rest of the year. You will need to apply for Marketplace coverage within 60 days of losing your job-based coverage. Your coverage can start the first day of the month after you lose your job-based coverage.

You may also be able to keep your job-based health plan through COBRA continuation coverage. COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee.

If you are injured at work, workers’ compensation will likely cover you. However, many employees are afraid to file a claim for fear of losing their job while on workers’ compensation. Your employer cannot fire you for filing a workers’ compensation claim, but they can terminate you for other reasons while your claim is still open. If you lose your job while on workers' compensation, it does not typically affect your legal right to those benefits.

Losing workers' compensation insurance due to aging out of a parent's plan

If you are covered under your parent's employer policy, you have until the end of the month when you turn 26 to choose a new health insurance plan. If you have coverage under your parent’s ACA marketplace plan, you have until the end of the calendar year (December 31) before your coverage ends—even if you turn 26 mid-year.

Aging out of your parent's plan makes you eligible for a Special Enrollment Period, so after turning 26 you can sign up for your plan within a specific 120-day period or during the year-end Open Enrollment Period. That particular Special Enrollment period begins 60 days before you're dropped from your parent's plan and ends 60 days after you lose coverage.

• Employer plans: This is how most people in the country get their health insurance. Employer-based coverage is usually cheap because the employer pays for most of the cost of insurance.
• COBRA: You can stay on the same plan through the Consolidated Omnibus Budget Reconciliation Act (COBRA). However, insurance through COBRA is usually very expensive because you have to pay for the full cost of your insurance plan.
• Short-term plans: You can turn to short-term policies to bridge coverage gaps. It's important to note that short-term plans do not have to cover pre-existing conditions and they also don't have to offer the same level of coverage as regular health insurance policies.
• Marketplace plans: You should consider a plan from the ACA marketplace if you are self-employed, a gig worker, or don't have coverage through a job. You may qualify for premium tax credits, also known as marketplace subsidies, if you have a low income.

It's important to plan ahead and be prepared for aging out of your parent's health insurance plan. This will ensure that you don't experience any gaps in your health coverage.

Losing workers' compensation insurance due to divorce

Divorce can have a significant impact on your workers' compensation benefits, and the specific effects will depend on the laws of your jurisdiction. In general, if the injury occurred during the marriage and you received the settlement before the divorce, it may be considered a joint marital asset. On the other hand, if the injury occurred after the divorce, the settlement is typically regarded as your separate property and is not subject to division.

It's important to note that regular disability payments from workers' compensation can be considered when determining alimony or spousal support. Your ex-spouse may argue that these payments reduce the need for additional alimony. However, you may also contend that these benefits are specifically meant to address injury-related needs and may not be equivalent to regular wages.

Additionally, divorce can alter who qualifies as a dependent for workers' compensation benefits. If you have custody of your children, they may continue to receive the full dependent benefit. However, in cases of shared custody or if your ex-spouse is granted custody, the distribution of these benefits may need to be renegotiated or litigated.

To protect your rights and ensure an equitable outcome, it's advisable to consult with a local attorney who is well-versed in these matters. They can guide you through the potential impacts of divorce on your workers' compensation benefits and help you navigate any legal complexities that may arise.

Losing workers' compensation insurance due to employer being uninsured

If you lose your workers' compensation insurance due to your employer being uninsured, this is considered a criminal offence. In California, this is punishable by a fine of up to $10,000 or imprisonment in county jail for up to one year, or both. The state can also impose a penalty of up to $100,000.

If you are injured at work and your employer is uninsured, they are responsible for paying all bills related to your injury or illness. You can file a civil action against your employer in addition to filing a workers' compensation claim. You may also file a claim for benefits with the state's Uninsured Employers' Benefit Trust Fund (UEBTF).

If your employer does not have the funds to pay your workers' compensation benefits, they will be paid by the UEBTF. This state agency has funds to pay benefits to injured workers. However, if you have a civil case and are paid by the UEBTF, you will have to pay them back with the money you recover in the civil case.

To file a claim with the UEBTF, you must put together three identical packets, each including:

• An Application for Adjudication of Claim
• Special Notice of Lawsuit to notify the employer
• Medical reports documenting the work injury
• Medical expense bills related to the work injury
• Proof of employment, such as pay stubs or a W-2 form from the time of injury
• A report that the employer did not have insurance
• Petition to Join Party Defendant UEBTF

Losing workers' compensation insurance due to employer fraud

Understanding Workers' Compensation Insurance

Workers' compensation insurance provides benefits to employees who suffer work-related injuries or illnesses. It covers medical expenses and helps replace lost wages during the recovery period. This type of insurance is designed to protect both employees and employers by providing a no-fault system, meaning employees don't need to prove negligence to receive benefits.

Employer Fraud in Workers' Compensation

Employer fraud in workers' compensation occurs when employers intentionally misrepresent or falsify information to reduce their insurance premiums or avoid providing coverage altogether. This can include misclassifying employees, underreporting payroll, or lying about the existence of workplace safety programs. Such actions are illegal and can result in significant penalties.

Impact on Employees

When employers engage in fraud, it can have a direct negative impact on employees. Employees may find themselves without the necessary coverage if they suffer a work-related injury or illness. This can lead to financial hardship and a lack of support during their recovery.

Legal Consequences for Employers

Employers who commit workers' compensation fraud are subject to legal consequences, including fines, penalties, and even jail time. Additionally, they may be required to reimburse any funds received fraudulently. In some cases, employer fraud can also lead to civil lawsuits filed by affected employees.

Preventing and Reporting Fraud

It is essential for employees to be vigilant and report any suspected fraud to the appropriate state authorities. Employers should also take proactive measures to prevent fraud, such as correctly classifying employees, maintaining accurate payroll records, and educating employees about workers' compensation policies and procedures.

Impact on Insurance Costs

Workers' compensation fraud has a significant financial impact, with estimates suggesting it costs insurers and employers billions of dollars annually. Ultimately, this leads to higher insurance premiums and affects the overall cost of doing business.

Protecting Yourself as an Employee

If you suspect your employer of fraud or are facing challenges in receiving your rightful workers' compensation benefits, it is crucial to document everything, keep records of your injuries and medical treatment, and seek legal advice. You may also want to report your concerns to the relevant state agency, such as the Division of Workers' Compensation or the local District Attorney's office.

Frequently asked questions