Last Updated on March 20, 2025 by The Young Firm
Many maritime workers are provided maritime health insurance through their employer. After a work-related accident, employers will often tell maritime employees to use this private health insurance to cover the injuries.
This is very rarely, if ever, the best option for seamen covered under the Jones Act.
What You Should Know about Health Insurance as an Injured Seaman:
Many health insurance plans do not cover injuries sustained at work.
If you use your health insurance, you must always be clear that your accident was work related.
You may have to pay back the health insurance company for your medical bills.
Your company may ruin your claim if you use your health insurance (even if they told you to use it in the first place).
Companies have their own insurance for maritime employee accidents, but they will avoid notifying their insurance to avoid premium increases.
Using your own health insurance should be a last resort.
You won’t necessarily lose your health insurance if you file a maritime injury claim.
Many health insurance plans do not cover injuries sustained at work.
There’s a very good chance that your health insurance does not pay for injuries sustained in work-related accidents. These companies often have a provision stating that there is no insurance coverage for work related medical care. Your health insurance policy should have a section called “Exclusions/Limitations” or something along those lines. As an injured worker, it’s crucial that you check your policy – even if your employer has told you that your insurance will provide financial relief.
If You Use Your Health Insurance, You Must Clearly State that the Injury is Work Related
If you choose to charge your medical bills to your private health insurance, make sure you clearly state that the treatment relates to a work injury. We always advise our clients and potential clients in the maritime industry to be very honest and specific when providing their histories to their treating physicians.
Fully Explain How the Injury Happened
As an injured seaman, your doctor must fully understand that this was a work-related injury that occurred on a vessel or oil rig while you were working. You should also provide this information on any medical form you receive over the course of your treatment. It is critical to give a full account of the circumstances surrounding the accident, and to have proof that you are not trying to misrepresent the nature of your injury.
Our office has seen many cases where a maritime employer told an injured worker to use their own health insurance to pay for medical bills. Once they did, the employer claimed fraud by saying that the injured party misrepresented the nature of the accident or injury.
If your insurance chooses to cover treatment, it will not harm your Jones Act claim, since you have been fully honest. However, if you choose to use your private health insurance, you will likely be creating a debt that you eventually have to repay.
You May Have to Pay Back the Health Insurance Provider
Another concern with using your own health insurance relates to the lien or subrogation rights that your insurer will have for any medical bills they cover.
Almost every private health insurance policy states that if a third-party claim is filed (like a claim against your employer under the Jones Act), then the provider is allowed to recover compensation for all costs it has paid for medical care, up to the amount that you may recover through your suit. In other words, if your insurer pays $50,000 in medical costs, your insurer is then entitled to receive the full $50,000 payment out of any money that you may recover under your case. If your private health insurance company pays for medical expenses, in almost all circumstances, you will be obligated to repay your medical expenses.
If your employer had properly paid for your medical expenses since the beginning of your injury as required by law, you would not need to pay any of your settlement money back to your health insurer.
It Can Complicate Your Maritime Injury Case
A practical concern that injured employees have in regards to using their own health insurance to cover a work-related injury is that it may delay their Jones Act claim. Very often, employers will instruct injured workers to put their health care expenses on their own insurance. They do this in an effort to avoid recognizing the injured worker’s Jones Act claim. When the worker does eventually obtain counsel or try to resolve the Jones Act claim, it may appear that they were trying to hide that the injury occurred at work.
How to Know if You Have a Maritime Injury Case or Jones Act Insurance Coverage
If you are an injured maritime worker who was involved in a work accident on navigable waters, the Jones Act applies to you. If you are an injured maritime worker dealing with illness caused by work conditions, or any other work-related issue, then it is likely that the Jones Act applies to you. This means that it is almost always best to insist that your employer pay your medical benefits rather than claiming your medical expenses on your own private health insurance.
Using your own insurance should be a last resort if your employer refuses to pay. In this case, make sure you clearly state that the injury happened at work, so that you can file a Jones Act claim without having to worry about employer retaliation.
Your Company May Not Properly Notify Its Insurance Provider
Another problem that may arise is that the company never notifies their provider of an injured seaman’s maritime injury claim.
Generally speaking, vessel companies and oil rig companies have specific insurance which covers work-related injuries. The companies are aware that injuries happen in this line of work, so they purchase insurance to protect them should a work injury happen. It is their responsibility to notify their insurance company once an injury claim is filed. It is important, and usually best, for these insurance companies to become involved at the very beginning of a claim.
However, your employer will often try to hide an injury claim from their insurance company in order to prevent their premiums from increasing. This can be very harmful, so you want to always make sure that your company is properly reporting your injury and the need for your medical treatment to its insurance carrier.
Do You Lose Health Insurance and Benefits if You File a Jones Act Claim?
Many workers who have sustained seaman’s injuries in the workplace are forced to take months of recovery time. Losing this much working time leads them to worry that they will lose their health insurance benefits or their entire family’s benefits. This can be a scary thought, especially on top of the mental anguish caused by lost wages and a challenging medical condition.
Will your company drop your benefits after a maritime injury accident? The answer is no.
Your company will not necessarily drop your health insurance just because you have a work-related accident and you can’t work.
In order for a company to drop health insurance benefits for an employee, there has to be what’s called a “triggering event.” This usually means that you’re being terminated by the company. Most employers are afraid to terminate an employee who has an injury.
Normally, the company simply carries on the payroll, pays your workers’ compensation or maintenance and cure benefits and then waits to see whether the doctor is going to release you to go back to work. So, most of the time your company is not going to stop your health insurance benefits for you or your family just because you have a maritime injury.
An Overview of Your Legal Rights Under the Jones Act
If you are considering a Jones Act Claim, it’s important that you understand the basics.
The Jones Act, or the Merchant Marine Act, is a federal law that allows you to sue employers for negligence that led to your injury. Employer negligence could mean a variety of things, like unsafe working conditions or accidents caused by another employee. The Jones Act allows offshore workers, harbor workers, and other Jones Act seamen to pursue compensation through such legal options as settlements and jury trials.
The Jones Act also requires your employer to provide worker’s compensation benefits until you reach maximum medical improvement, which means that your condition is either fully treated or that it is not going to improve with further medical care.
If you are able to recover, this means that you don’t have to worry about returning until you are absolutely ready. If you have a lasting condition and are unable to return, then you may be able to recover compensation that will sustain you and your family for years to come.
Hiring an Experienced Maritime Attorney for a Jones Act Claim
The Jones Act requires you to prove negligence, which is why it is crucial to have a maritime injury attorney on your side. An experienced Jones Act lawyer is different than a general personal injury attorney, as they specialize in Jones Act coverage for maritime industry accidents.
If you’re an injured seaman who is ready to seek compensation for your lost wages and medical expenses, reach out to an experienced attorney for a free consultation. Our attorneys offer free case evaluations so that you can learn about your legal rights and options under the Jones Act.
Learn More About Receiving Payments After a Maritime Injury
Our team at The Young Firm knows that figuring out how to pay for medical treatments after suffering a maritime injury can be incredibly frustrating. We are happy to help you find the right course of action for you and your family. Contact our offices online or call 504-680-4100 to speak with a Jones Act attorney who can advise you on your rights and choices under maritime law.
