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another insurance question...

Discussion in 'Business Operations' started by GarPA, Aug 21, 2002.

  1. GarPA

    GarPA LawnSite Silver Member
    from PA
    Messages: 2,585

    The other post we had on the absolute needneed for commercial coverage got to me thinking about my personal group health ins coverage. I have every base covered on liability and commercial auto...also have a million on an umbrella policy.
    It is more cost effective for my wife and I to puchase health ins through her group plan at her employer, rather than me carrying my own individual policy(very costly)...then I got to thinking...lets say the Z rolls over on me and I break a leg and end up with big medical bills....now since this accident occured in 'my business ', can the company deny coverage for my medical bills??? I was in the prop/cas biz for a long time and should be able to answer my own question but I'm having a brain fade on this....I think I'm ok because its really no different than if i worked in a bakery and was carried on my wifes group plan and then burned my arm.....my coverage should take care of the dr. bills...Nothing about this has anyhing to do with workers comp...I'm not concerned about that separate issue...thanks for your 2 cents.
  2. DLCS

    DLCS LawnSite Platinum Member
    Messages: 4,386


    I do lawn care part time. I was told that my employer (for my full time job) would not be responsible for any medical bills that ocurred, while I was making money at my business(getting injured while doing something for profit). If you worked for someone else and you got hurt on there time, they would be responsible for your medical bills not your wifes employer. If you get hurt on the job that falls into workman's comp insurance.

  3. TJLC

    TJLC LawnSite Bronze Member
    Messages: 1,308

    Good question. My wife also carries our medical ins at her work. Last year I cut my hand and couldn't work. Her ins covered all my bills for that, but I was hurt at home and not on the job. I think I should check into that now that you mention it. Thanks.
  4. Big G

    Big G LawnSite Member
    Messages: 48

    I believe that as long as you are not covered by any other medical insurance, your wife's policy should cover your medical expenses no matter what they were the result of, your work or just an injury caused by whatever else.

    That's my understanding of the situation.

    Big G
  5. Big G

    Big G LawnSite Member
    Messages: 48

    As a follow-up to my earlier reply, the issue brought up by Mike about Workman's Comp having to pay the bills and not a medical insurance policy is true ONLY IF Workman's Comp is in effect at your employer.

    In other words, since you are not required by law to have/provide Workman's Comp Insurance coverage, Medical Insurance would then have to cover the bills relating to the injury.

    I know that this may vary by state, but in my state of Missouri, small companies are not required to comply with the law regarding Workman's Compensation. I think this is any Company with fewer than 5 employees, I may be mistaken about the number of employees, but I am certain that extremely small companies are exempt from Worker's Comp Laws.

    Big G
  6. GarPA

    GarPA LawnSite Silver Member
    from PA
    Messages: 2,585

    thanks for your perspectives...hope we get some more because I'll bet there are quite a few us who tag along on our spouses coverage...and if theres any wiggle room for them to deny coverage we need to know that..... probably should read the group plan document but of course I have no idea where it is....
  7. GarPA

    GarPA LawnSite Silver Member
    from PA
    Messages: 2,585

    well I just dug out the master conract and quickly reviewed the 50 pages focusing on 'exclusions' and 'eligibility' sections. I could not find anything that indicated I would be denied coverage if injured in my business. But there may be fine print somewhere else that I missed
  8. Hawkeye5

    Hawkeye5 LawnSite Senior Member
    Messages: 295

    Hey Kitzy, nice to see another refugee from the P&C Industry!! Like you, I never really was involved with the Health end of the business. If your wife's group plan has no exclusions regarding Workers Compensation for spouses, you may be alright. Health coverage tries to make itself excess over any other valid and collectable coverage, or mandates coordination of coverage with other coverage that applies. My guess is that the situation may vary by group plan or state. JD
  9. dforbes

    dforbes LawnSite Member
    Messages: 195

    My wife works as an underwriter for an insurance company, so i can tell you how it works in Missouri. Since I have more than 5 employees I am required to carry workmans comp. on my employees. There is an option for the owner to opt out, meaning that my workmans comp does not cover me. Since i to have insurance thru my wifes policey I do opt out. Why pay twice for insurance. If you were in Missouri you are covered no matter howor where the accident happens. Most states have a state insurance board that you can call and they will answer these lkind of questions. Hope this helps.
  10. TurfGuyTX

    TurfGuyTX LawnSite Senior Member
    from DFW
    Messages: 648

    Well hopefully you never have to use the insurance. This post has got me thinking. (ouch) :D How many of you have disability insurance? A broker sold me some a couple of years ago. It's something I thought I'd never need. With the freak 4 wheeler accident I had last year, I didn't lose a beat (financially) The $7500 I got for the loss of vision in one eye made it a little easier to deal with. If any of you can afford disability insurance, I'd definately recommend it. I'll give you my broker's name if you want. Good luck.

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