Last reviewed October 2026

An employee is off work on workers’ comp. Do we have to keep their group health insurance going?

Short answer: If the employer is covered by the FMLA and designates the absence as FMLA leave, yes, for up to 12 weeks. Beyond that, the employer’s leave policy and the plan’s eligibility rules decide, applied consistently.

A workers’ compensation absence can also be a serious health condition under the FMLA, and the two may run at the same time if the employer gives proper notice and designates the leave as FMLA leave. During the FMLA portion, group health coverage must be maintained on the same terms. Because comp is not unpaid, neither side can require substitution of paid leave while comp benefits are paid, though they may agree to use paid leave to top up comp where state law permits.

If the doctor releases the employee to light duty, the employee may decline it. They may lose comp payments but can stay on unpaid FMLA leave until the 12 weeks run out.

After FMLA, or at an employer not covered by the FMLA, coverage depends on the leave policy and plan terms. A loss of coverage because of the absence is a reduction of hours for COBRA purposes. In Texas, an employer may not fire or discriminate against an employee for filing a workers’ compensation claim in good faith, hiring a lawyer, or testifying; a violation can mean damages and reinstatement.

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