Do I Lose Health Insurance on Workers Comp? What to Know If Your Employer Cancels Benefits After Injury

Estimated reading time: 14 minutes

Key Takeaways

• Filing a workers’ compensation claim does not automatically end employer health coverage; workers’ comp pays for accepted work-injury care while group health, FMLA, and COBRA handle other coverage.
• If you remain employed and on leave, your employer plan typically continues as long as you pay your employee premium share; if terminated, COBRA/Cal-COBRA can bridge coverage.
• Using your health plan for work-injury treatment can cause denials or reimbursement (subrogation) requests—send bills to the workers’ comp insurer instead.
• In California, strong anti-retaliation rules and Cal‑COBRA protections can help you keep coverage during transitions.
• If your employer cancels benefits after you’re hurt, document everything, demand a written reason, review the plan’s SPD, request COBRA, and escalate to the DOL or California DWC as needed.

Do I lose health insurance on workers comp is the most common question we hear from injured employees. The short answer: filing a workers’ compensation claim does not automatically end your employer-provided health insurance — workers’ comp covers work-related medical care while employer group plans, FMLA, and COBRA determine continuation of other benefits.

• Workers’ comp generally pays 100% for accepted work-related treatment (no standard copays). See Pond Lehocky and The Hartford’s overview of workers’ comp vs. health insurance.
• If you remain employed and on leave, employer-sponsored coverage typically continues (you pay your share). See Whitley Law Firm’s FAQ and Farrin’s guide.
• If terminated, COBRA or state “mini‑COBRA” may let you keep the same plan by paying full premiums (plus up to 2% fee). See Whitley.
• California residents: Cal‑COBRA can extend continuation coverage up to 36 months and state anti‑retaliation rules are strong—see the California Division of Workers’ Compensation (DWC).

Workers’ compensation vs. employer health insurance: what each covers

Workers’ compensation is a state-mandated system that pays for medical care for accepted job injuries and partial wage replacement (often about two‑thirds of the average weekly wage). It applies only to work-related injuries and is administered by the employer’s workers’ comp insurer or a state fund. See a clear overview from The Hartford and the U.S. Department of Labor.

Employer group health insurance—often governed by ERISA for private employers—covers non-work care (like chronic conditions, family care, or preventive visits). Premiums are typically shared by employer and employee per plan rules. See Whitley’s FAQ and this Wolters Kluwer expert insight.

For accepted work injuries, workers’ comp is the primary payer for injury-related treatment. If you run work-injury bills through your health plan, you risk denials or subrogation (your health insurer paying, then seeking reimbursement from the comp carrier). See guidance from NPHM and Pond Lehocky.

Who pays for what

• Work-related medical treatment: workers’ compensation (no standard copays/deductibles if authorized and accepted).
• Non-work medical care: your employer health plan (subject to copays, deductibles, and network rules).
• Employee premium share: still owed by you if employer health coverage continues while you’re on leave.

Why you shouldn’t use your health plan for a work injury

Submitting job-injury bills to your health plan can cause denials or subrogation (the health plan pays then seeks repayment from workers’ comp). It’s cleaner and faster to route accepted work-injury bills through the workers’ comp insurer. See NPHM’s explanation.

Quick answer: Do I lose health insurance on workers comp?

No—filing a workers’ comp claim does not automatically end your employer health insurance; coverage usually continues while you remain employed or protected by law. See Whitley and Farrin.

Scenario A: You’re on leave and still employed

Your employer typically continues contributing its portion of premiums if the plan rules allow, and you must keep paying your share (through payroll deduction or direct billing). Workers’ comp pays for accepted injury care. See Pond Lehocky.

Scenario B: You’re terminated after filing a claim

Your group health coverage may end, but COBRA (or state mini‑COBRA) typically lets you continue the same plan if you pay the full premium plus up to a 2% administrative fee. You usually have 60 days to elect COBRA. See Whitley.

Scenario C: Your employer stops paying premiums while you’re still employed

If this is tied to your claim, it may be illegal retaliation. Document notices, request a written reason, review the plan rules, and consider legal advice. See Whitley.

What bills you may receive now

• Injury-related care: should be billed to the workers’ comp insurer (no standard copays if accepted and authorized).
• Non-work care: continues under your group plan (you owe any copays/coinsurance).
• Unexpected bills for accepted work care: ask the provider to re-bill the workers’ comp insurer and contact the adjuster immediately.

When can an employer cancel or change benefits?

Plan rules and ERISA basics. Private employer health plans are often subject to ERISA, and the plan documents—especially the Summary Plan Description (SPD)—govern eligibility, termination rules, and appeal procedures. See Whitley and the benefits guidance at the U.S. Department of Labor’s EBSA. For broader workers’ comp law context, see Wolters Kluwer.

Anti‑retaliation. Employers generally cannot terminate, demote, or cancel benefits solely because you filed a workers’ comp claim. Retaliation is unlawful in many states and may be actionable. See Whitley and Pond Lehocky.

Legitimate reasons for changes. Employers can change benefits for business-wide reasons, or end contributions if you no longer meet eligibility (for example, hours drop below a threshold) or if a non-retaliatory layoff occurs. The difference between legitimate changes and retaliation is often proven by documentation, timing, and consistent application of plan rules.

If your employer cancels or changes coverage suspiciously, take these steps:

1. Document every communication (dates, names, copies of notices).
2. Request the written reason for the termination/change.
3. Ask HR for the plan’s SPD and the appeal instructions.
4. Demand continuation or a COBRA election notice in writing.
5. File an ERISA/benefits appeal within plan deadlines (often 60 days—check the SPD), and contact EBSA if needed.
6. Consider a state retaliation complaint and speak with a workers’ comp attorney.

For California-specific help navigating claims and disputes, see our guide to filing a California workers’ comp claim.

Insurance coverage during work injury leave (FMLA, COBRA, and Cal‑COBRA)

FMLA basics. Eligible employees can take up to 12 weeks of unpaid, job‑protected leave, and the employer must maintain group health benefits on the same terms (you still owe your share of premiums). See the DOL/EBSA and background from Farrin. In California, FMLA may run concurrently with CFRA; here’s a deeper dive on FMLA vs. workers’ comp (and CFRA) in California.

Short‑term disability & employer leave. Short‑term disability (STD) is a payroll/benefit program and runs per plan contracts; if your injury also qualifies, FMLA/CFRA time may run concurrently (check your plan and HR).

COBRA & Cal‑COBRA. If employment or eligibility ends, COBRA generally gives you 60 days to elect continuation; federal COBRA usually applies to employers with 20+ employees for up to 18 months (longer in some cases). Cal‑COBRA can extend continuation (and may cover smaller employers). See Whitley and the California DWC.

Example timeline

• Day 0: Injury occurs; report to your employer and open a workers’ comp claim.
• Week 0–2: Initial treatment authorized and paid by workers’ comp (if accepted).
• Week 1–12: If on FMLA, employer must maintain group health benefits on the same terms.
• Week 12+: If you’re still off work and employment ends, the employer sends a COBRA notice (within 14–60 days depending on the trigger); you have 60 days to elect.

Eligibility shifts. If you return to reduced hours and fall below the plan’s eligibility threshold, employer contributions may stop. Ask HR—in writing—for a benefits status letter.

Premium handling during leave. If premiums aren’t being deducted, arrange payment directly with HR/benefits and request written confirmation that your coverage stays active.

Timeline at a glance (graphic alt-text)

Alt-text: “Timeline from work injury to COBRA: Injury → report to employer (Day 0) → file workers’ comp claim (Days 0–7) → initial medical care paid by workers’ comp if accepted (Days 0–30) → FMLA protection with employer-maintained health benefits (Weeks 0–12) → return to work or, if employment ends, COBRA election window (60 days); federal COBRA up to 18 months or Cal‑COBRA up to 36 months.”

Caption (for accessibility): This sequence shows how insurance coverage during work injury leave can shift from workers’ comp-paid injury care to FMLA-maintained group health, and later to COBRA/Cal‑COBRA if employment or eligibility ends.

Medical coverage while on workers’ compensation

How authorization works. Report the injury right away and file a claim. Your employer or its workers’ comp insurer authorizes initial treatment; use an authorized provider and confirm—ideally in writing—who authorized the visit. See Pond Lehocky.

What’s covered. Workers’ comp typically pays 100% for medically necessary treatment for accepted injuries, including doctor visits, imaging, surgeries, physical therapy, prescriptions, durable medical equipment, and, when appropriate, vocational rehab—without standard copays/deductibles. See The Hartford and Pond Lehocky. For a full benefits refresher, see our guide to workers’ compensation benefits.

Billing problems and disputes. If a provider or health plan bills you for an accepted workers’ comp service, don’t pay immediately. Ask the provider to re-bill the comp insurer and contact the adjuster. If that fails, file a billing dispute with your state board and keep copies of all bills and communications. See Whitley and NPHM. We also explain how to stop collections in our guide on workers’ comp unpaid medical bills.

Subrogation and coordination. If your health plan pays in error for work-injury care, it may seek reimbursement from the comp insurer. That’s another reason to route bills directly to workers’ comp. See NPHM.

What to do if you’re billed for an accepted service

1. Save the bill and note the date of service.
2. Confirm the service was authorized by the comp insurer.
3. Ask the provider’s billing office to re-bill the workers’ comp carrier.
4. Call the adjuster and notify HR of the error.
5. If unresolved, file a complaint with your state workers’ comp board.

For California-specific treatment rules and help, see our overview of medical coverage in workers’ comp.

State spotlight: How a job injury affects health insurance in California

California protections. The Division of Workers’ Compensation (DWC) oversees medical and disability claims. Cal‑COBRA can extend continuation coverage up to 36 months for certain small-employer situations. California also has strong anti‑retaliation provisions and active enforcement. See the California DWC.

Cal‑COBRA. Cal‑COBRA applies to employers with 2–19 employees (or other scenarios not covered by federal COBRA) and can extend continuation longer than federal COBRA. Check your plan notice and DWC resources for current timelines: dir.ca.gov/dwc.

Practical CA steps and contact info (verbatim): “If you’re in California: contact the Division of Workers’ Compensation at https://dir.ca.gov/dwc and call the DWC Information and Assistance Unit at 1-800-736-7401 for help filing a complaint or getting clarity on benefit continuation.”

Filing retaliation complaints in CA. Document the action and submit an online complaint to the CA Labor Commissioner or DWC as appropriate; request a hearing if benefits were improperly cancelled. See DWC. Always verify the latest California statutes and timelines before taking action.

Common scenarios and Q&A

Scenario 1 — On approved leave long‑term (still employed)

Who pays and how: Workers’ comp pays accepted injury care; employer health coverage continues per plan rules if you pay your share. If premiums aren’t payroll-deducted, ask HR to invoice monthly and confirm coverage in writing. When returning to light duty, benefits typically resume under standard eligibility rules. See Pond Lehocky.

Sample confirmation request to HR: “Please confirm whether my group health coverage remains active during leave, how my employee premium share will be collected, and any deadlines to avoid lapse.”

Scenario 2 — Terminated after filing

You should receive a COBRA notice if the group plan ends; elect within 60 days if you want continuation. If the timing suggests retaliation, document it and consider a complaint. Workers’ comp medical and disability benefits continue regardless of employment status. See Whitley and Farrin. For navigating long claims in California, review how long benefits may last: How long can you be on workers’ comp in CA?

Scenario 3 — Small employer (no federal COBRA)

You may qualify for state mini‑COBRA (Cal‑COBRA) or consider marketplace plans (with potential subsidies) and Medicaid if eligible. Workers’ comp remains the payer for accepted injury care. See the California DWC.

Scenario 4 — Provider bills you for an accepted workers’ comp service

Follow the re-billing steps above and escalate to the adjuster and state board if necessary. A structured approach helps stop collections; see our practical guide to unpaid medical bills in workers’ comp.

Quick Q&A

• Can an employer cancel benefits after injury? Not for filing a claim—that’s often illegal retaliation. Benefits can change for legitimate reasons under plan rules; document and appeal. See Whitley.
• Will workers’ comp pay my medical bills? Yes, for accepted work-related care; health insurance covers non-work care. See Pond Lehocky and The Hartford.
• Does filing a claim mean I lose employer benefits? No, not automatically; review plan terms and local laws. See Farrin.

What to do if your employer cancels benefits after injury — step‑by‑step checklist

1. Save and date all communications (emails, texts, mailed notices). Keep scans.
2. Request plan documents: ask HR for the SPD and proof of premium payments.
3. Ask HR in writing for the reason and, if terminated, for a COBRA election notice.
4. Confirm whether you’re eligible for FMLA/CFRA and how premiums will be handled on leave.
5. If you get a bill for work-injury care, don’t pay—request re-billing to the comp carrier.
6. File plan appeals per SPD/ERISA instructions within deadlines (often 60 days—verify). See DOL/EBSA.
7. File state complaints (workers’ comp board or labor commissioner) and federal complaints where applicable (EBSA for COBRA/FMLA issues). California DWC: dir.ca.gov/dwc.
8. Consult a workers’ comp/ERISA attorney if retaliation or coverage denial persists. For California steps after a claim denial, see our appeals guide.

Sample HR email (you can adapt):

Subject: Request for Written Confirmation of Health Coverage Status — [Your Name]
Hello [HR name], I am writing to confirm the status of my employer‑sponsored health insurance following my work‑related injury on [date]. Please confirm in writing whether my coverage remains active, whether employer premium contributions will continue, and provide any COBRA/continuation notices if my employment or eligibility has changed. I am also requesting the plan’s Summary Plan Description. Thank you, [Name, contact info].

Sample dispute note to provider billing office/health insurer:

Re: Billing dispute for date of service [date] — Patient [Name], Claim # [workers’ comp claim number]. This service resulted from a work‑related injury reported on [date]. Please re‑bill the workers’ compensation insurer [insurer name] and confirm re‑billing in writing. Enclosed: claim form and employer report. Do not pursue collections while this dispute is pending.

Deadlines to track:

• COBRA election window: 60 days to elect after notice (see DOL/EBSA).
• ERISA/plan appeals: commonly 60 days for initial appeals (confirm in your SPD).
• State complaints: windows vary—file promptly and check your state agency pages; in California, see the DWC.

How to keep continuous coverage and minimize gaps

• Continue the employer plan via COBRA/Cal‑COBRA. Pros: same doctors/network. Cons: you pay full premium + ~2% admin; can be costly ($500–$1,500+/mo by plan). See Whitley and California DWC.
• Pay your premiums directly while on leave. Pros: lower cost if the employer still subsidizes. Cons: not always permitted by plan—get written confirmation.
• Marketplace/individual plan (ACA). Pros: potential subsidies if income drops. Cons: new network and cost-sharing. See HealthCare.gov.
• Medicaid/CHIP. Pros: low/no cost if eligible. Cons: income/household limits; coverage varies by state—check your state Medicaid site.
• Short‑term plans. Pros: cheaper bridge. Cons: limited coverage and exclusions (often exclude work injuries).

Cost planning tip: Ask HR for the total monthly premium, not just your share, so you can compare COBRA vs. employer‑subsidized options accurately. If continuity with your current doctors is critical, prioritize COBRA; if cost is prohibitive, compare marketplace and Medicaid options quickly.

Resources you can use

• U.S. DOL/EBSA (FMLA/COBRA/ERISA guidance and complaint intake)
• U.S. DOL Workers’ Compensation basics
• Whitley Law Firm: Who pays for health insurance on workers’ comp?
• Pond Lehocky: Who pays your health insurance while on workers’ compensation
• Farrin: Will health insurance continue during workers’ comp?
• NPHM: How workers’ comp and health insurance work together
• The Hartford: Workers’ comp vs. health insurance
• California Division of Workers’ Compensation (Help line: 1‑800‑736‑7401)
• Wolters Kluwer: Workers’ compensation laws—expert insight

For broader California-specific guidance on filing, benefits, and timelines: How workers’ comp works in California.

Conclusion

Workers’ comp and employer health insurance serve different purposes: workers’ comp pays for work‑injury care, while your group health plan, FMLA, COBRA, and Cal‑COBRA govern ongoing health coverage. You usually do not lose health insurance just because you filed a claim—especially if you remain employed or are within protected leave periods. If your employer cancels benefits suspiciously, act quickly: document, demand a written reason, review your SPD, request COBRA, and escalate to the DOL/EBSA or California DWC if needed. Keep all injury‑related bills routed to the workers’ comp insurer, and consider COBRA/Cal‑COBRA, marketplace, or Medicaid options to avoid gaps in care.

This article is for informational purposes only and not legal advice. Laws and benefits vary by state and situation. Consult a qualified workers’ compensation or ERISA attorney for advice about your case.

Need more help understanding insurance coverage during work injury leave, or how do I lose health insurance on workers comp applies to your situation? Our detailed guides on FMLA vs. workers’ comp and filing a workers’ comp claim in California can help.

Need help now? Get a free and instant case evaluation by Visionary Law Group. See if your case qualifies within 30-seconds at https://eval.visionarylawgroup.com/work-comp.

FAQ

Do I lose health insurance on workers comp?

No—filing a claim does not automatically end your coverage. Workers’ comp pays for work‑injury care; employer plans typically continue while you’re employed or on protected leave, and COBRA/Cal‑COBRA can extend coverage afterward. See Whitley and Pond Lehocky.

What happens to insurance coverage during work injury leave?

FMLA (if eligible) requires your employer to maintain group health coverage on the same terms for up to 12 weeks; if employment ends, COBRA or Cal‑COBRA may allow continuation. See DOL/EBSA, Whitley, and the California DWC.

Who pays for medical treatment while on workers’ compensation?

Workers’ comp pays 100% for authorized, medically necessary treatment for accepted work injuries; your group health plan covers non-work-related care. See Pond Lehocky and The Hartford.

Can my employer cancel my benefits after I’m injured?

Not for filing a claim—that can be unlawful retaliation. Employers may make plan‑wide or eligibility‑based changes per plan rules, but they must follow notice and appeal procedures. See Whitley.

Should I use my health plan for a work injury?

No. For accepted injuries, workers’ comp is the primary payer; using your health plan can trigger denials or subrogation. See NPHM.