What Is The Workers’ Compensation 90 Day Rule?

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Workers’ compensation allows you to pursue a legal remedy if you get hurt while performing your work duties.

While traditionally you must prove negligence or wrongdoing to recover compensation when you believe someone hurt you, this isn’t necessary for a work injury. You can’t sue an employer when you are harmed on the job, but you can make a workers’ compensation claim and recover compensation–even if your employer wasn’t negligent and didn’t do anything wrong.

State workers’ compensation laws dictate what your rights are when you are hurt at work and it’s important to know what rules and requirements apply to you. In some states, for example, you must be aware of the workers’ compensation 90 day rule and how it impacts your case.

What Is the Workers' Compensation 90 Day Rule?

Understanding workers’ compensation rules can be complicated for a simple reason. Each state sets its own individual rules and requirements for how the workers’ comp system operates.

As a result, the workers’ compensation 90 day rule does not mean the same thing in every location. In fact, some places have a 90-day rule, but others don’t.

Workers’ Compensation 90 Day Rule in Pennsylvania

Pennsylvania is one example of a state that has a workers’ compensation 90 day rule. In PA, the rule relates to how you can seek medical care after a work injury.

Your medical bills are paid by your employer’s workers’ compensation insurer when you get hurt doing your job. But you may not get your costs covered if you don’t see the right doctor.

PA’s 90 day rule specifies that employers can post a list of “panel physicians” in an obvious place that workers are easily able to see–and can mandate that injured workers initially seek treatment from one of these doctors. Workers must be informed of their obligation to see a doctor on this panel and must sign off on their knowledge of this information when hired and after an injury happens.

Employees whose employers follow these requirements must visit one of the panel doctors for any treatment within the first 90 days of the time the workplace injury occurred in order for their treatment to be paid for by the workers’ comp insurer. If an employee sees a different doctor within the first 90 days, workers’ comp does not necessarily have to cover the cost.

Once 90 days have passed, an employee is not required to keep seeing a panel physician and can select any licensed medical care provider to offer treatment–as long as the care is both necessary and related to the work injury.

Many other states also have rules that allow an employer to choose which doctor a worker sees–at least initially. For example, in Arizona and Colorado, workers must see a doctor chosen by the company for the first visit before choosing any licensed care provider they prefer to get additional care. And in Maine, workers must see a doctor chosen by their employer for the first 10 days of treatment.

While the specific requirements for how long you must see a company doctor can vary depending where you live, it is important to know the rules that apply to you so you don’t see the wrong physician and jeopardize your coverage.

If you are required to see a doctor chosen by your employer, your company generally must make a list of providers available to you and, in many cases, you may be required to sign off on an acknowledgement that your options for a caregiver are limited initially after a work injury.

Workers’ Compensation 90 Day Rule in California

In California, the workers’ compensation 90 day rule is different.

Under California law, workers’ comp insurers must respond to your claim within 14 days of the time a work injury claim form is submitted. In some cases, employers will delay a decision on a claim. Employers must provide up to $10,000 in medical care during this delay period but don’t have to pay temporary wage loss benefits during this time period when the claim is delayed.

If employers delay a claim, they then have a period of 90 days in which they can review and respond to it. If more than 90 days have passed, then the claim is presumed to be accepted so your medical bills, lost wages and other eligible costs related to the work injury should be covered.

Other states also set deadlines for employers to respond. If you believe your claim is taking too long, you should seriously consider reaching out to an experienced work injury lawyer for help moving things forward so you can get the benefits you deserve after suffering an injury at work.

How to Understand the Workers' Compensation Rules in your State

The workers’ compensation 90 day rule is just one of many you may need to be aware of after a work injury. State workers’ compensation regulations impose many requirements, including mandates that you report injuries in a timely manner.

You do not want to do anything to jeopardize your claim or your right to benefits so it is often best to speak with a work injury lawyer as soon as possible after you are hurt on the job. Your attorney can help you to make smart choices during the claims process so you can maximize the money you receive after you get hurt at work.

Frequently Asked Question (FAQs)

What is the longest you can be on workers' comp?

The length of time you can receive workers’ comp benefits depends on your state’s rules and the severity of your injury. While you may be capped at between three to seven years of temporary disability benefits, permanent disability benefits can sometimes continue indefinitely through to retirement age.

How long do you have to file for workers' comp?

You should report a work injury as soon as possible. In many cases, there is a deadline for reporting the incident that harmed you (such as a 30-day time limit for filing an initial injury claim).

Your state may also have a timeline for how quickly your claim must be processed. For example, in California, the workers’ comp insurer has 14 days to get back to you on your claim, or up to 90 days to make a decision when they delay. Under the workers’ comp 90-day rule in that state, if more than 90 days have passed, your claim is considered compensable by default.

How long do most workers' comp settlements take?

Sometimes, workers’ comp claims are resolved through settlements. When you settle, you get a lump sum or the insurer agrees to enter into a structured payment schedule and provide funds over time. It can take between 12 to 18 months for many workers’ comp claims to settle but the time for your own claim could be longer or shorter depending on the severity of your injuries and whether you can agree on a settlement or a hearing is necessary.