Can I Use My Own Insurance Instead of Workers’ Comp?

My short answer: you should almost always try to use workers’ compensation insurance, not your own health insurance, for a work injury. Here’s why.

1. No co-pays, no deductibles, no out-of-pocket bills

Under workers’ comp, there are no co-pays or deductibles for approved treatment. When your claim is accepted and the bills are handled correctly, you should pay $0 out of pocket for covered care.

With private health insurance, you’re dealing with:

• Co-pays

• Deductibles

• Co-insurance / patient portions

Every dollar matters, especially when you’re missing work. Those costs should not be your responsibility when you were hurt doing your job and workers’ comp coverage is available.

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2. Using your own insurance can create a mess

When you run a work injury through your private health insurance, things can get complicated fast:

• Your health insurer pays some bills at first…

• Later, they realize it should have been a workers’ comp claim and they want their money back (this is called subrogation).

• We then end up tracking down what the health insurer paid, getting workers’ comp to reimburse them, and cleaning up the paper trail.

Sometimes it’s even worse:

• The health insurer pays your doctors,

• Then claws the money back from the providers once they find out it’s a work injury,

• Now the doctor shows you as the one with an unpaid balance,

• And we have to go back and get workers’ comp to pay that bill properly.

You might also get letters saying a “patient portion” is due or that part of the bill wasn’t covered, and then collection agencies start chasing you for something workers’ comp should have paid in the first place.

It is **so much simpler—and legally correct—**when all medical bills are sent to the workers’ comp carrier from the beginning.

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3. When it can make sense to use private insurance—for a moment

There are situations where I may tell a client to consider using their own insurance temporarily, but it’s usually because the workers’ comp carrier is dragging its feet or denying the case:

• Workers’ comp is “investigating” and not approving treatment yet, or

• They send you to their IME (independent medical exam) doctor, who says you don’t need any more treatment, and the insurer cuts you off.

At that point, you often have two choices:

1. Get no treatment and go straight to trial, or

2. Use your own health insurance for now to keep the medical side moving.

For example, we might need:

• Your treating doctor to respond to the IME report, or

• A new MRI or specialist visit so we can bring stronger evidence to trial.

In those situations, I may recommend using your private insurance briefly to get the opinions or tests we need to prove your case—but that’s a strategic decision we talk through together.

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4. Big surgeries and tough choices

Another common scenario: your treating doctor recommends a major surgery, and:

• Workers’ comp has sent you to an IME who says you’re fine,

• Workers’ comp denies the surgery based on that report,

• But you have good health insurance that will cover the surgery if you use the workers’ comp denial letter.

Now you’re stuck in a tough spot:

• Option 1:

  • Use your own insurance, have the surgery now, and (hopefully) get better faster.

  • But you’ll owe co-pays and patient portions, which can reach thousands of dollars.

• Option 2:

  • Refuse to use your own insurance, go to trial, and fight workers’ comp on the surgery.

  • That can take months and months with no treatment while you wait on a decision.

  • If we win, it’s the best outcome: workers’ comp pays and you didn’t have to put your own insurance on the line.

  • If we lose, you waited in pain and still didn’t get the surgery approved.

I like fighting these cases—we’ve won some excellent results on denied surgeries, and you can read about a couple of recent trial wins here. But it’s the worker who’s stuck in the middle, and different people make different choices depending on their pain, finances, and risk tolerance.

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The bottom line

• Workers’ comp should be paying under Illinois law.

• You were hurt doing your job, serving your employer.

• That’s what the workers’ compensation system is for.

Our job at McHargue & Jones is to fight insurance companies that don’t want to pay and help you navigate these complex decisions—when to push workers’ comp, when (if ever) to use your own insurance, and how to protect yourself from surprise bills and bad decisions made under pressure.

There are a lot of moving parts and tough choices. A good workers’ comp lawyer can walk you through the options so you’re not trying to figure all of this out on your own.

Confused About Which Insurance Should Be Paying?
If you were hurt at work in Illinois and you’re stuck between workers’ comp and your own health insurance, don’t guess. The wrong move can leave you with bills, denied treatment, or lost wage benefits.

Call McHargue & Jones at (312) 739-0000 or click here to request your free workers’ comp case review. We’ll look at your situation, explain which insurance should be paying, and fight to make sure you’re not left holding the bag. No fee unless we win.