Workers’ compensation pays for medical treatment related to your workplace injury, but it doesn’t pay your regular health insurance premiums. While your employer may continue paying its share of your employer-sponsored health insurance while you remain employed, you usually must continue paying your share to maintain coverage.
Joye Law Firm Injury Lawyers has helped injured South Carolinians since 1968. We stand with the underdogs: the injured workers who feel pressured by employers, insurance companies, and benefit administrators.
If you have questions about your workers’ comp claim, your health insurance coverage, or your legal options, contact us for a free consultation.
Workers’ Comp Does Not Pay Your Health Insurance Premiums
Workers’ compensation and health insurance serve different purposes. In South Carolina, most employers with four or more employees must carry workers’ compensation coverage. Workers’ compensation benefits cover approved medical care related to a job-related injury and wage replacement benefits if you cannot work for more than seven days. Regular health insurance usually covers medical expenses unrelated to your work injury, such as routine care, prescriptions, family coverage, or treatment for other conditions.
Because these are separate benefits, the workers’ compensation insurance company generally does not pay your monthly health insurance premiums. If you have employer-sponsored health insurance and remain employed while recovering, your employer may keep paying its usual portion of the premium. However, you will likely still need to continue paying your part of the premium.
Why Your Employment Status Matters for Health Insurance
Many injured workers assume they lose their health insurance as soon as they begin receiving workers’ compensation benefits. In reality, that is not usually how it works.
Whether your health insurance continues while you’re receiving workers’ compensation benefits depends on your employment status and the terms of your employer’s group health plan. While it can happen, being on workers’ comp does not mean you will be fired, laid off, or removed from the group health plan. Most injured workers remain employees while receiving workers’ compensation benefits.
If you remain employed while recovering, your employer may continue making its usual contribution toward your health insurance premiums, while you remain responsible for your share. The challenge is that your share may no longer come out of a regular paycheck if you are not working.
For example, assume your employer paid 70 percent of the premium before your injury, and you paid 30 percent through payroll deductions. If your employer continues the group health plan while you are out on workers’ comp, they may continue paying 70 percent. You may still owe the 30 percent.
Missed premium payments can put your coverage at risk. Do not assume your employer will pause, forgive, or deduct the amount later. Your employer may ask you to send premium payments directly to payroll, human resources, or the employer’s health plan administrator.
Ask for written instructions confirming:
- How much you owe
- When payment is due
- Where to send it
- Who to contact with questions
Getting this information in writing can help prevent an accidental lapse in coverage. Keep proof of every payment. Save emails, receipts, canceled checks, and letters from your employer, the insurance provider, or the health plan administrator.
How FMLA Can Protect Group Health Plan Coverage
The Family and Medical Leave Act (FMLA) can affect who pays your health insurance if you qualify for FMLA protection while on workers’ compensation. Under FMLA, eligible employees of covered employers may take job-protected leave for qualifying medical reasons while maintaining their group health benefits under the same conditions as if the employee had kept working.
When workers’ compensation and FMLA apply at the same time, the two programs serve different purposes. Workers’ compensation may provide partial wage replacement and medical help, while FMLA may protect your job and health coverage for a certain period. These laws can work together, but they do not replace each other.
If FMLA applies, you must continue making your normal contribution to your health insurance premiums. Because the rules governing workers’ compensation, FMLA, and employer-sponsored health plans can overlap, you should confirm with your employer how your leave is being classified and what you need to do to keep your health coverage active.
What Happens If You Lose Your Job or Health Coverage?
Your employer cannot legally fire or demote you simply because you filed a South Carolina workers’ compensation claim in good faith. South Carolina Code Section 41-1-80 prohibits an employer from discharging or demoting an employee because the employee started or participated in a workers’ compensation proceeding.
Still, workers’ compensation does not create unlimited job protection. An employer may argue that a job ended for reasons unrelated to the claim. If your employer terminates your employment, cuts your hours, or ends your eligibility for the group health plan, your health insurance coverage may change.
At that point, COBRA may apply. Continuation of Health Coverage (COBRA) is a federal law that allows workers and their families to keep job-based health coverage for a limited time after certain events, such as job loss or reduced hours. The U.S. Department of Labor states that COBRA gives workers and their families the right to choose to continue group health benefits for limited periods after events such as voluntary or involuntary job loss or reduced work hours.
COBRA can help prevent a gap in coverage, but it can be expensive. You may have to pay the full premium, including the portion your employer previously paid, plus any applicable administrative fee.
Warning Signs That Your Health Coverage Needs Legal Review
Health insurance disputes during workers’ compensation cases can create real financial risk. You should speak with an attorney if your employer or insurance company gives unclear answers about coverage, premiums, or your job status.
Possible warning signs include:
- Your employer says your health insurance ended without giving written notice
- Your employer refuses to explain how to continue paying your premium
- Your medical bills for your work injury are sent to your regular health insurance instead of workers’ comp
- Your employer threatens your job, benefits, or hours after you file a workers’ comp claim
- You receive COBRA paperwork, but do not understand your deadline or payment amount
These problems can affect medical care, family coverage, and your ability to keep treatment on track. They can also signal deeper disputes in your workers’ compensation claim.
FAQ
WC - Health Insurance
Can my spouse or children stay on my health insurance while I am on workers’ comp?
Yes, they may be able to stay covered if your employer-sponsored health insurance remains active and you continue paying the required premium for family coverage. Workers’ compensation benefits do not usually change dependent coverage on their own. The bigger issue is keeping the group health plan active while you are away from work.
Can my employer require me to pay my health insurance premium by check instead of through payroll deduction?
Yes. If you are not receiving a regular paycheck, your employer may ask you to pay your share of the health insurance premium in another way. That may include a check, online payment, or another approved method. Ask your employer’s health plan administrator for written instructions so you do not miss a payment deadline.
Can I use my regular health insurance if workers’ comp delays approval for treatment?
If your treatment is related to a workplace injury, workers’ compensation should generally be responsible for approved medical care under the claim. Your regular health insurance provider may deny payment or seek reimbursement if the bill should have been paid by workers’ comp. Before using regular health insurance for a work injury, it is wise to speak with a workers’ compensation attorney.
Will my health insurance premium be deducted from my workers’ comp check?
Usually, no. Workers’ comp checks are not regular payroll checks, so health insurance premiums are often not deducted automatically. You may need to make separate premium payments to keep coverage active. Confirm this with your employer in writing.
Can I lose health insurance if I do not return to work after my doctor releases me?
Possibly. If your doctor releases you to work and your employer offers suitable work, refusing to return may affect your workers’ compensation benefits and your employment status. If your employment ends or your hours change, your health insurance coverage may also change. Speak with a member of our legal team before making decisions that could affect your benefits.
How We Help Injured Workers Protect Benefits During a Workers’ Comp Claim
At Joye Law Firm Injury Lawyers, we know a workplace injury can create questions that go far beyond medical treatment. Concerns about health insurance coverage, premium payments, and employment status often add unnecessary stress during an already difficult time.
Everything we do is rooted in our 4 Core Values: compassion, bravery, continuous improvement, and respect for the common good. We’re here to take on challenges and ensure injured workers are treated fairly during their workers’ compensation claim.
Our team helps alleviate stress by reviewing claim documents, benefit notices, and messages from your employer, insurance company, or your employer’s health plan administrator. We also help determine which bills should go through workers’ comp and which may belong under regular health insurance. When employer disputes arise, we explain your legal options and help protect your workers’ comp claim.
Joye Law Firm Injury Lawyers has earned national recognition for our work representing injured workers. Our firm was included in the 2026 edition of The Best Law Firms in America, with Regional Tier 1 rankings for workers’ compensation law for claimants in Charleston, Columbia, and Greenville. Managing Partner Ken Harrell was also named Best Lawyers 2026 Workers’ Compensation Law – Claimants “Lawyer of the Year” in Charleston.
Our attorneys don’t just practice workers’ compensation law, they help lead the profession. Ken Harrell and Matt Jackson are Past Presidents of Injured Workers’ Advocates (IWA). Davis Rice has served on the organization’s Executive Committee, while several other Joye Law Firm attorneys are active members. Their leadership reflects our longstanding commitment to protecting the rights of injured workers across South Carolina.
If you are considering filing a workers’ compensation claim after a work injury and have concerns about premium payments or continued health insurance coverage, contact us for a free consultation.
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