February 21, 2023

Workers’ Compensation 90-day Rule

The workers’ compensation 90-day rule is an important element of workers’ comp law if you plan on recovering damages for a workplace-related accident. This rule varies per state, with some having no such rule at all.

Generally, in the states that do have it, the rule requires workers to report their injury or illness to their employer within 90 days. Even when your employer is not negligent in your case, you can file a workers’ comp claim to recover compensation. Here are more details.

Examples of States With a Workers’ Compensation 90-day Rule

California is one state with a unique workers’ compensation 90-day rule. Employers in the state must provide their employees with no-fault work insurance. If you file and submit a workman’s comp claim, your employer’s workers’ comp insurer must respond to it within 14 days. However, your employer can delay the decision on your claim.

They would provide up to $10,000 in medical care but won’t cover temporary wage loss benefits during the delay period. Employers tend to delay claims, so they have time to review them and respond accordingly. If they delay it for too long, they become liable by default. Thus, they will cover all eligible costs associated with your work injury, including medical bills and lost wages.

Meanwhile, Pennsylvania has a different workers’ compensation 90-day rule. Instead of a deadline, it specifies the kind of medical care you must seek after surviving a workplace injury or illness. Generally, you can only obtain compensation from your employer’s workers’ comp insurer if you see a doctor from their official list of panel physicians.

Your employer must post that list in a conspicuous area. They must also inform you about the panel when they hire you, which you must sign off on in case an injury happens in the workplace. This way, anyone who might need medical care for their injuries will know which doctors to seek initial treatment from.

After the initial 90 days, you can visit another doctor outside of the approved panel of physicians. However, the healthcare provider you choose must offer treatments that are relevant to your workplace injury to qualify for workers’ compensation. Seeing the wrong physician may jeopardize your workers’ comp coverage.

Arizona and Colorado also have the same kind of rule where you must choose from a list of licensed care providers before you can choose another one outside of your company’s approved physicians. In Maine, you would only need to complete the first 10 days of initial treatment with an approved doctor instead of 90.

What Kind of Injuries Does Workers’ Compensation Cover?

The National Safety Council identified three top categories of workplace-related injuries and illnesses. These categories are:

  • Exposure to Harmful Substances: Depending on the nature of your job, you may incur injuries when you are exposed to electricity, radiation, extreme temperatures, noise, changes in water or air pressure, harmful substances, contagious and infectious diseases, oxygen deficiency, and stressful or traumatic events. If you survived an incident after exposure to any of these events, you may have grounds to file a workers’ comp claim.
  • Overexertion and Bodily Reaction: There are two kinds of workplace injuries in this category. First, non-impact injuries result from excessive physical activity — usually involving heavy objects that you would lift, carry, push, or throw. Second, repetitive motion injuries are small tasks that accumulate stress or strain in your body but don’t necessarily involve excessive effort, such as carpal tunnel syndrome.
  • Slip and Fall Injuries: If you slip, trip, and fall in certain events at work, you can file a workers’ comp claim. These injuries include slips and trips without falling, which would occur when you catch yourself before you fall and injure yourself any further but still sustain a level of injury. Another example is falling on the same level, such as when your workplace forgot to leave a “caution” sign for a wet floor. Furthermore, you could fall to a lower level because of a collapsed floor or broken staircase.

Final Words: Get a Workers’ Compensation Lawyer To Assess Your Circumstances

Different states have unique workers’ compensation 90-day rules to determine how you can obtain compensation for the injuries you survive in the workplace. Generally, it serves as a time limit for when you must file your claim to recover damages. Other states use the rule to guide workers on which doctors they must visit within the set period.

Understanding the rule that your state follows is critical in obtaining compensation. Otherwise, you risk not getting financial coverage for your workplace injury. Consider speaking to a professional workers’ compensation lawyer who understands the 90-day rule in your area to help you navigate the legal system.