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Is an employer responsible for out of network medical costs during business travel?

Discussion in 'Employee Benefits, Pensions' started by sebvad, Mar 2, 2012.

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  1. sebvad

    sebvad Law Topic Starter New Member

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    I work for a global multi-national company, and my role requires me (and our group) to travel frequently to 3rd world countries where there is a higher than average likelihood of medical need (ranging from potential to hospitalize due to food poisoning to gunshot wounds and snake bites). We have US based insurance coverage (HMO) which offers coverage at a significantly reduced rate while out of network - obviously 3rd world countries are out of network for this insurance.

    The assumption has always been that should we require medical attention while in the field, the company would cover those costs. Recent events with a coworker have cast that into significant doubt, with the company indicating that the individual's primary insurance is their fallback protection, and any out of network costs - regardless if they're incurred as out of network as a result of business sanctioned/mandated travel - are the employees responsibility.

    From a US employment law perspective, is there a legal expectation of full medical backing from your employer due to medical costs incurred while travelling abroad for business?
     
  2. army judge

    army judge Super Moderator

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    No.
    Just as there would be no requirement for an employer to cover your non-work related medical costs while you were in a state that your HMO did not cover you.



    Sent from my iPad2 using Tapatalk HD
     
  3. cbg

    cbg Super Moderator

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    Not even close. Your HMO should cover emergency or urgent care regardless of where you are, and if it's not urgent or emergent, you shouldn't be getting the care while you're located outside the network anyway.

    Even in the two states where employers are required by law to provide health insurance, there is no requirement that the employer pay for any non-covered care incurred while you are on company business. If there were such a law, what would prevent employees from waiting to have any non-urgent or elective medical treatment until they were on the company's dime?
     
  4. sebvad

    sebvad Law Topic Starter New Member

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    Thanks - Wow did i misread that one. So, just to be clear, if i'm in the bush for work, and break my leg, get shot, or have a heart attack (for work, not recreation), those expenses incurred as a result of being out of network are on me? HMO is covering a portion of emergency care, but not 100%, my coworker is being told by the employer that that part which isn't being covered by HMO needs to come from him.
     
  5. cbg

    cbg Super Moderator

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    Your employer has NO legal responsibilty to pick up those costs that are not covered by your insurance. None. Zip. Nada. Zilch. You are 100% responsible for those out of network costs that are not covered by your insurance. I do not know how to make it any more clear than that.

    If the injury is incurred IN THE COURSE OF your work (you break your leg tripping over a piece of equipment on your way across the field office) then that's a workers comp claim and the costs are all on your employer. But just being in an out of network area for work does not make it the employer's responsibility - if you break your leg tripping over the night table in your hotel room that's NOT on your employer, even if you're in that hotel on your employer's dime while you're traveling for work). And good luck getting a heart attack covered on workers comp without more than one doctor being ready to declare under oath that you would not have had the heart attack if you'd been employed elsewhere.
     
  6. disagreeable

    disagreeable Well-Known Member

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    That said, some policies will reimburse some expenses for out of country care, though they usually require the records be translated into english and adjust for the exchange rate.
     
  7. army judge

    army judge Super Moderator

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    That isn't what you originally posted.

    If you are injured in the scope of performing your duties as an employee, you are covered by workman's compensation insurance for medical expenses and some of your lost wages during your rehabilitation.

    If your employer is self insured, your employer will cover the medical costs, as well as some of your lost wages during your rehabilitation.

    Now, you as an employees, often receive substantially less than what you would have received, had the injury occurred in the uS or Canada.

    In some cases, you might receive nothing, but most employers will assist you.

    http://www.riskvue.com/articles/rb/rb0301c.htm

    What you originally asked about was "medical expenses" for personal injury or illness, while working abroad.

    Now your inquiry about medical expenses incurred while on assignment abroad, but in the course of your employment duties changes the question and the answer.




    Workers compensation is defined as: a disability compensation program (or insurance plan) which provide wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits to employees who are injured at work or acquire an occupational disease in the course of performing their employment duties.
     
    Last edited: Mar 5, 2012
  8. sebvad

    sebvad Law Topic Starter New Member

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    Thanks all. i understand i may be using language that may mean something different to me than it does to you, and don't want to get tripped up on the jargon. I also understand that your'e saying that simply incurring a medical cost while in the course of work (regardless of location) does not place the burden on the employer; unless that happened in the course of an act of work. Good to understand where the lines are, thanks for your time.
     

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