The Jones Act and private insurance: What you should know

As a seaman or dock worker in New York, you probably already have some form of private insurance in place. If you are injured at work, you may be told by your employer to just use that insurance to receive medical treatment. At Tabak Mellusi & Shisha LLP, we see these types of situations all the time and often explain to our clients why this is not a good idea.

Under the Jones Act, you are legally entitled to medical care, and you also have the right to file a lawsuit against the owner of the ship or company for damages related to your injury. This is important because employees who are not covered under the Jones Act must rely on the state’s workers’ compensation program, which does not give them the right to a trial. The Free Dictionary states that the Jones Act was established to give seamen the same rights as workers on land.

This right means your employer is obligated to pay for your medical care – not your own insurance company. By encouraging you to use your own insurance, the employer may be planning to argue that your injury was not work-related because you used private coverage. Likewise, relying on your private insurer can actually hinder the process of seeking damages under the Jones Act, which means it can take longer for you to receive a payment or judgment.

Under the terms of your private health insurance policy itself, the chances are high that it explicitly states that work-related injuries are not covered. If it does, your insurer has the right to put a legal claim on any monies that you receive from your lawsuit. Perhaps you suffer a severe injury that led to a medical care cost of $75,000 and you use your own insurance. You sue the owner of the ship and receive $100,000. Rather than receiving $100,000 however, you would have to pay the insurance company the full $75,000. For more information concerning injury and the Jones Act, please visit our web page.