Private Health Insurance and the Jones Act

If you are an offshore maritime worker and you suffer an injury at work, very often you will be faced with the decision of whether or not you should use your private health insurance to pay for medical treatment related to your work injury. The Jones Act will typically apply to your case, and there are at least three important reasons that you should not use your own private insurance to pay for medical treatment relating to a maritime injury.

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 health insurance companies have language in your insurance policy which states that the insurance company has a lien or right to be repaid any money that they pay for medical treatment in the event that you recover money from a third party. In other words, even if your health insurance company does pay for medical treatment relating to your injury, when you try to resolve your claim or you present your claim in court, your health insurance company will require that you repay them for any medical expenses which they covered. Sometimes this lien can make it difficult to resolve your Jones Act claim with your employer since you essentially owe your own insurance company money out of any potential settlement that you may receive.

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.

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.

Learn more about the Jones Act