The Uninsured Injured Worker

Case Management Focus

Workers' Compensation is in place to address workplace injuries and ensure the injured worker gets the care they need to heal and return to gainful employment. There is no cost to the employee for any care under workers compensation insurance.  

But what happens when an injured worker has a illness or injury that is not related to the work injury and does not have medical insurance to enable them to get care? This happens because  employers may not offer health insurance for their employees, or the employee cannot afford coverage.  

According to Forbes, health insurance is a vital part of financial planning that helps pay for people's healthcare. This can include doctor and hospital bills, annual doctor visits, specialist visits, prescription drugs, mental health services, dental care, eye care, and other medical-related expenses. 

Today, many Americans struggle to afford the cost of health insurance. According to the Kaiser Family Foundation, 64.2% of uninsured non-elderly adults (between ages 18 and 64) report that the top reason why they don’t have health insurance is because the cost is too high. 

The main reasons people give for not having health insurance include the following:  

• The average annual single premium per enrolled employee for employer-based health insurance in the U.S. is $7,590/year, with employees contributing $1,637 and employers contributing $5,953 annually.  

• The average annual deductible per enrolled employee in employer-based health insurance is $3,811/year for families and $1,992/year for single coverage.  

• The average monthly cost for a PPO plan in the ACA marketplace for a 30-year-old adult is $512. The same plan for a 60-year-old adult is $1,224/month.  

So, what does a nurse case manager do when an injured worker comes down with a non-work-related injury or illness? In this article, I want to share some strategies that you can consider.  

1. Does the person qualify for Medicaid?  

2. Visit Healthcare.gov. This government website is there to help you get health insurance coverage if you do not get or afford healthcare insurance through your employer.  

3. If you can't afford any health plan and don’t qualify for coverage through Medicaid and the  

Children’s Health Insurance Program (CHIP), you can get low-cost health care at a nearby community health center. How much you pay depends on your income. Community health centers are located in both urban and rural areas. Community healthcare centers provide various services for people and their families. Locate a community health center near you. 

4. Emergency Department: Anyone can go into an emergency department and be evaluated and receive care. Once there, the ED case manager may have additional resources for people with limited income who require medications and follow-up care.  

5. Work within your community to find resources to help people with minimal or no coverage.  

6. Talk to your federal or state legislative leaders to share your concerns and how policy decisions impact your communities' health and welfare.  

It is not easy when faced with people with no medical insurance, and workers' compensation nurse case managers will see these types of care more and more as employers either raise rates for their employees to have healthcare as their costs continue to rise or stop paying for healthcare insurance altogether.  

If you have any ideas to share, please feel free to email me at allewellyn48@gmail.com  

Reference:  

Forbes Health Insurance Facts and Stat for 2025: https://www.forbes.com/advisor/health-insurance/health-insurance-statistics-and-facts 

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