Can My Private Health Insurance Be Used Under The Jones Act?
Many seamen are provided health insurance through their Jones Act employer. When these individuals suffer a work-related injury under the Jones Act, very often their employers will ask them (or even tell them) to use their private health insurance to pay for medical treatment related to their work injury. There are several concerns about using your own medical insurance to pay for a work-related injury under the Jones Act.
One concern with attempting to use your own private insurance to pay for a work-related maritime injury relates to the language of your insurance policy. Many private health insurance policies contain language which states that the policy does not provide coverage for a work-related injury. Very often maritime employers will request or even instruct an injured employee to use their own private health insurance to pay for medical treatment relating to a work injury. If the employee does not fully describe to his doctors that his injury occurred at work, sometimes the employer will later claim that the employee was essentially committing fraud by using his private health insurance to pay for a work-related injury. In short, your employer may try to accuse you of trying to cheat your own private health insurance if you try to obtain medical treatment for a work-related injury through your private insurance. Many employers will do this even if the employer itself requested for you to use your own private health insurance!
Also, most private health insurance policies give your insurance company a lien for any medical expenses that they pay on your behalf. A lien allows your insurance company to receive full repayment for any medical expenses which it paid on your behalf. This repayment will come out of any money or settlement that you receive for your Jones Act claim. In other words, if you are later able to successfully resolve your Jones Act claim and you receive any type of settlement or judgment, in all likelihood your health insurance company will require that you repay any medical expenses which it paid on your behalf relating to your work injury. So instead of having your employer properly pay medical expenses for which it is responsible, sometimes you ultimately end up paying back your own private health insurance for such medical expenses.
One other concern with using your private health insurance to pay for medical treatment relating to a Jones Act injury is a practical effect that using your private insurance has upon your claim. Many Jones Act employers will have the injured employee use his private insurance for months and months of medical treatment following the original injury. This can sometimes delay the official filing of a claim under the employer's Jones Act insurance. Even though the injured Jones Act employee has done nothing wrong, many times it is difficult to move a claim forward if the employer's insurance company was not made aware of the claim until months and months later. It is always best to immediately report any type of Jones Act injury and also require that your employer pay for all medical expenses rather than putting these expenses on your own insurance.
If you have suffered an injury at work under the Jones Act, in almost all cases it is best to insist that your employer pay your medical benefits rather than claiming your medical expenses on your own private health insurance. Using your own insurance should be a last resort if your employer refuses to pay under the Jones Act; and then, make sure you clearly state that the injury happened at work.
One concern with attempting to use your own private insurance to pay for a work-related maritime injury relates to the language of your insurance policy. Many private health insurance policies contain language which states that the policy does not provide coverage for a work-related injury. Very often maritime employers will request or even instruct an injured employee to use their own private health insurance to pay for medical treatment relating to a work injury. If the employee does not fully describe to his doctors that his injury occurred at work, sometimes the employer will later claim that the employee was essentially committing fraud by using his private health insurance to pay for a work-related injury. In short, your employer may try to accuse you of trying to cheat your own private health insurance if you try to obtain medical treatment for a work-related injury through your private insurance. Many employers will do this even if the employer itself requested for you to use your own private health insurance!
Also, most private health insurance policies give your insurance company a lien for any medical expenses that they pay on your behalf. A lien allows your insurance company to receive full repayment for any medical expenses which it paid on your behalf. This repayment will come out of any money or settlement that you receive for your Jones Act claim. In other words, if you are later able to successfully resolve your Jones Act claim and you receive any type of settlement or judgment, in all likelihood your health insurance company will require that you repay any medical expenses which it paid on your behalf relating to your work injury. So instead of having your employer properly pay medical expenses for which it is responsible, sometimes you ultimately end up paying back your own private health insurance for such medical expenses.
One other concern with using your private health insurance to pay for medical treatment relating to a Jones Act injury is a practical effect that using your private insurance has upon your claim. Many Jones Act employers will have the injured employee use his private insurance for months and months of medical treatment following the original injury. This can sometimes delay the official filing of a claim under the employer's Jones Act insurance. Even though the injured Jones Act employee has done nothing wrong, many times it is difficult to move a claim forward if the employer's insurance company was not made aware of the claim until months and months later. It is always best to immediately report any type of Jones Act injury and also require that your employer pay for all medical expenses rather than putting these expenses on your own insurance.
If you have suffered an injury at work under the Jones Act, in almost all cases it is best to insist that your employer pay your medical benefits rather than claiming your medical expenses on your own private health insurance. Using your own insurance should be a last resort if your employer refuses to pay under the Jones Act; and then, make sure you clearly state that the injury happened at work.
About the Author:
Learn more about how to handle your claim under the Jones Act at Jones Act Law.com. Author Timothy Young has helped injured seamen for years and he specializes in Jones Act law.
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