More then 40 million Americans still lack health insurance, despite the Affordable Care Act (“Obamacare”), and large medical bills remain a significant cause of personal bankruptcy.
Unfortunately, even those with health insurance sometimes fall into a Catch 22 arising from competing policy exclusions. Worker’s compensation benefits don’t apply to non-work-related medical problems, and most health insurance policies don’t apply to injuries suffered on the job.
For example. one of our self-employed clients got hurt at work, but his worker’s compensation carrier refused to pay for his surgery because a doctor hired by that carrier concluded that the injury was not work-related. (This is a common defense in wear-and-tear injury claims.) At the same time, our client’s health carrier also refused to pay because it considered the surgery a work-related problem, for which it provided no coverage. This case of clashing bureaucracies resolved in our client’s favor, but only after two hearings before the Worker’s Compensation Division.