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.
First, many health insurance companies have a provision in their policies which states the insurance does not pay for work-related injuries. If you choose to charge your medical treatment to your private health insurance, make sure you clearly state that the medical treatment relates to a work injury. Also be sure to give a full history of how the injury occurred so that it is clear you are not trying to misrepresent the nature of your work injury. Our office has seen many cases where an injured Jones Act employee is actually told by their employer to use their health insurance to pay for medical treatment and later the employer tries to claim that the injured Jones Act seaman misrepresented the nature of his injury since he claimed it on his own private health insurance. Again, it is critical that you clearly state that your injury occurred at work if you are going to put any medical treatment on your own health insurance.
Another concern with using your own health insurance to pay for a work-related injury under the Jones Act relates to the lien or subrogation rights that your insurer will have for any medical expenses paid by your insurer. Almost every private health insurance policy states that if a third-party claim is filed (or in this case your claim against your employer under the Jones Act) your health insurance company is legally allowed to recover from you all costs it has paid for medical treatment, up to the amount that you may recover through your suit. In other words if your insurer pays $50,000.00 in medical costs, your insurer is then entitled to receive the full $50,000.00 payment out of any money that you may recover under your Jones Act case. If your employer had properly paid for your medical expenses from the beginning of your Jones Act claim as required by law, you would then not need to pay any of your settlement money back to your own insurer.
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.
Under the Jones Act an injured seaman has the right to receive immediate medical treatment. This requires that the Jones Act employer pay for such medical treatment. Any attempt by the Jones Act employer to use the employee's private health insurance to pay for work-related injuries should be avoided at all costs. Your private health insurance is generally meant to cover you for non-work related injuries. The Jones Act, on the other hand, is meant to protect you if you suffer a work-related injury
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Don't ruin your Jones Act case. Learn more about the Jones Act by visiting www.JonesActLaw.com.
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