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Patrick, Esq.
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I need help with an expert in Workers Compensation Law. A

Resolved Question:

I need help with an expert in Workers Compensation Law. A friend of mine was just told by her employer that they would no longer be paying for her regular healthcare benefits. She filed a workers compensation claim back in July of this year and the workers compensation adjuster has been extremely slow in providing treatment to her. They keep postponing her appointments and to date she has not received a determination as to claim that she has worker related injury. Her doctors told her she should not go back to work yet. Her employer contacted her this week and told her that they would no longer pay for her regular healthcare benefits that she normally receives when she is working, which means she will not have access to any medical care for herself or her daughter while she is out on disability. Her employer told her that her benefits can continue under COBRA however there is no way that she can afford to pay for her healthcare benefits under COBRA because her only source of income is her disability payments. Can an employer that is responsible for causing an injury or illness to one of its employees be relieved of the responsibility to provide regular healthcare benefits to one of its employees because the employee cannot pay their portion due to the disability that suffered as a result of working for the employer?
Submitted: 3 years ago.
Category: California Employment Law
Expert:  Patrick, Esq. replied 3 years ago.
Good afternoon and thank you for entrusting me to assist you. My name is XXXXX XXXXX I will do everything I can to answer your question.

Unforutnatey, the answer to your question is "yes, an employer can force an employee to pay for his or her healthcare pursuant to COBRA while that employee is out on disability, even if the disability is for a work-related injury and even if the employee's lack of income due to the disability precludes them from paying for their premiums (which, by the way, through COBRA, will be substantially lower than they would be if your friend got new healthcare insurance on her own, since she continue sto enjoy the benefit of the group plan rate through COBRA).

Assuming your firned's injury truly is work-related, workers compensation will pay for all of her medical treatment. If the injury is determined not to be work-related, the unfairness you identified (forcing an employee to pay premiums they can't afford due to a work-related injury and inability to work) no longer exists, since the injury isn't work related after all.

The short answer that what you describe, while a truly unfortunate situation, does not violate any law. If the injury is truly work-related, however, workers comp will cover all expenses retroactive to the date of injury, so there should be no out-of-pocket loss to treat the injury.

Please do not hesitate to let me know if you have any questions or concerns regarding the above and I will be more than happy to assist you further.

If you do not require any further assistance, please be so kind as to provide a positive rating of my service so that I may receive credit for assisting you. Very best wishes and kindest regards.
Customer: replied 3 years ago.

The injury is work related and I know this to be true because I was her manager when the injury occurred. Unfortunately, the healthcare that this employer offers to its employees is terrible. It is the type of plan that used to be called a "catastrophic illness plan". High premeiums for the employee, huge deductibles, and huge out of pocket amounts. Nevertheless, that is what employees are stuck with should they opt to accept this kind of healthcare insurance plan.


This is just my opinion, but it seems absolutely incredulous that someone who was injured on the job isby law forced to pay the total amount of the monthly premiums for their employer's healthcare insurance plan while they are recovering from their injuries. I mean it is almost laughable to think that our lawmakers actually felt that employees that have suffered an injury at work and as a result their income has been reduced by 33 1\3 % can actually afford to pay the entire monthly premium amounts for their employer's healthcare plan that they were using before they sustained their injury?


This particular employer was definite at fault in this situation. It was not a no fault accident that occurred. This employee suffered months of mental anguish and abuse by the branch manager. I know, because I witnessed the abusive behavior on numerous occassions but was I was limited on the means that I could use to stop the branch manager. All I could do was to warn the district and regional offices that if he didn't cease harassing this employee, she was going to have a mental breakdown and that is exactly what happened. There are suppose to be laws that protect employees from employers like this but in realty they protect the employee at all, It is very sad that we continue to allow these kind of employers to behave this way towards their employees and the fact that we further punish the abused employee is beyond me . . . . . .

Expert:  Patrick, Esq. replied 3 years ago.

I agree it is highly unfortunate that the law does not provide more protection in this respect.

I'm surprised to learn the healthcare insurance of her employer is so bad and expensive (usually it's one or the other). The insurance available to her under COBRA should be cheaper than anything she can secure on her own because COBRA entitles her to the group plan rate--that's the whole point of COBRA, really.

Also, WC contingency fees are usually capped at 15% of the award. So, assuming your friend needs an attorney at all, her bills should mostly be covered through Workers Comp.

Unfortunately, whether or not the employer was at fault does not change things. Workers comp is what is called a "no fault system." In exchange for being able to collect on claims where the accident is no one's fault or even the employee's own fault, employees give up the right to sue the employer for "pain and suffering" damages in addition to their actual out-of-pocket expenses.

It seems your friend is falliing through the cracks a bit, and I am truly sorry to hear about that. I couldn't agree more that our legal system is flawed and far from optimal. I do hope, nonetheless, that I have adequately addressed your concerns as they relate to the law.

Please let me know if I can be of any further assistance with regard to your question.
Patrick, Esq. and other California Employment Law Specialists are ready to help you
Customer: replied 3 years ago.

Yes, you have been very helpful.


Thank you.

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