When tragic accidents occur on the job, it is good to know that you have both the medical insurance and workers’ compensation options to cover the costs of your medical care. Or do you? What if you are one of the few exceptions to your state’s workers’ compensation laws? What if your medical insurance denies your claim because you should be covered by workers’ compensation? This was the unfortunate cycle in which one Illinois farmer found himself recently.
Once Upon a Grain Bin
After Jason Haas fell off the ladder in his grain bin, his first thought was probably not about which insurance was going to cover the medical costs to repair his injuries. One ambulance ride and $87,000 worth of medical care to fix his broken leg and crushed vertebrae later, it probably crossed his mind, however. Haas, who carried medical insurance with Humana through a non-agricultural part-time job, filed a claim to cover the bills, but Humana denied his claim. The insurer stated that the injuries relating to the farm accident were not covered because he was working at a for-profit job and he should be covered by Illinois’ workers’ compensation insurance. Now Haas had reason to worry about those medical costs.
Illinois Exemptions
Workers’ compensation insurance and laws are supposed to cover the medical costs for injured employees. In Illinois, however, this coverage does not extend to agricultural workers, like Jason Haas, if the agricultural enterprise “employs less than 400 working days of agricultural labor per quarter in any quarter in the preceding year, excluding family members.” While any exempted Illinois agricultural employer can choose to participate in the state’s program for workers’ compensation, it is typically too expensive to be a viable option.
Health Insurance Intervention
Since Jason Haas couldn’t afford his own workers’ compensation coverage, his injuries were not covered by the state’s workers’ compensation insurance program and his medical insurer declined to pay for any of the medical bills related to his farming accident, he had to find help. After contacting a legal agency, his case went all the way up to the Illinois Department of Insurance (IDOI) Director Michael McRaith. McRaith agreed that Humana did not correctly apply Illinois law in Haas’ situation, stating that they rejected his claim based on state workers’ compensation coverage that was not available to Haas.
Getting What You Deserve
With pressure from the IDOI and a little bad press, Humana began covering Jason Haas’ extensive medical bills. In this case, Haas got what he deserved, but he had to fight for his insurance payments with the help of other legal and insurance professionals. When these types of unfair situations arise, it is best to seek the advice of an experienced Illinois workers’ compensation attorney in your area. Know your legal rights and options so you can avoid being stuck in an unfortunate cycle of insurance runarounds.
