One of the many difficult decisions an injured Jones Act Seaman sometimes has to make is whether or not he should use his private health insurance to pay for medical treatment relating to a work injury. Sometimes his employer will actually request or instruct the injured seaman to use private health insurance to cover medical expenses relating to a work injury. This article will address the pitfalls of using private health insurance to cover injuries which fall 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.
Finally, there is also a practical concern with using private health insurance to cover work-related injuries under the Jones Act. In a Jones Act claim it is always important to immediately notify your employer as well as your employer’s insurance company of your work-related injury. If private health insurance is used to pay for medical treatment immediately following your injury, this can sometimes delay the proper reporting of your work injury to your employer’s Jones Act insurance company. Then, when a delayed claim is filed months later, your employer’s Jones Act insurance company may contest your claim or dispute that it was properly reported to them in a timely fashion. It is best to immediately report your Jones Act injury and immediately require that your employer pay for all injury related medical expenses.
A Jones Act employer will have a very special insurance policy which provides insurance coverage for any work-related injuries to its employees. It is very important that all Jones Act injury claims be filed under this type of insurance. If you are asked to use your own private health insurance to pay for medical expenses relating to a Jones Act injury, it is best to refuse to do so. If your employer is not willing to pay for your medical expenses immediately following your injury, this is usually a good sign that you need to obtain an attorney since your employer is not even covering your basic right to medical treatment under the Jones Act.
Read more about the Jones Act or author Timothy Young by visiting www.JonesActLaw.com.
anyhow, health insurance is very important