Understanding the 90 day rule of workers comp
- Posted on: Jun 26 2023
When it comes to workers’ compensation law, one important piece to know about is the 90-day rule, which governs damages stemming from workplace injuries. While the rule will depend on the state that you reside in, you need to be sure that your state has this rule or not.
For the most part, the states that have the 90-day rule require the injury to be reported to the employer within the 90 days in which it occurs. Regardless of negligence being present, a claim for workers’ compensation can be submitted for compensation to be recovered.
Few Cases in Point of the 90-day Rule
The state of California has a unique 90-day rule for workers’ compensation. All employers in California need to have work insurance that is “no-fault”. When a claim is filed for workers’ compensation, the insurer has 14 days to respond. Despite this, a delay of the decision can take place from the employer.
If a delay occurs, the employer will provide medical care up to a maximum of $10,000 but not pay any wage loss that the delay may cause.A delay will usually take place so that the claim can be reviewed completely so that response is appropriate. When delay runs past 14 days, liability is by default and coverage and lost wages must be paid.
Pennsylvania is another state with a different 90-day rule for workers’ compensation. As opposed to a time limit, the medical care provided must come from a specific healthcare provider. This provider will be a part of a list of providers that the insurer works with. So when you seek medical care, it must be through a listed provider.
The list of approved providers must be visible in a common work area that all employees can view. Employees must also be notified of the provider list upon hiring and a form stating this information must be acknowledged and signed. When this is acknowledged, the employees will be aware of providers who can be seen following a workplace injury.
Following the 90 days, injured workers are at liberty to obtain additional care from different providers as long as the treatment provided is related to the injury sustained in order for workers’ compensation to be claimed and obtained. If the correct provider is not seen, the coverage for workers’ compensation could be jeopardized.
The states of Colorado and Arizona have similar 90-day rules that require injured staff to seek care from the insurer’s provider list prior to seeking other care.
For Maine, only 10 days is needed for initial care instead of 90 days.
Putting It All Together
It is obvious that the 90-day rule will be different for all states involving compensation and the method allowed to obtain workers’ compensation coverage. Basically, the 90-day rule is a time limit for filing your claim for benefits. This rule can also be a guide for workers to choose an approved provider.
When you are in need of a better understanding of this rule, you should get in touch with us today to better explain the 90-day rule.