Workers compensation 90 day rule
Halt | November 10, 2022 | 0 Comments

Workers Compensation 90 Day Rule – Details

The workers compensation 90 day rule is created to protect injured workers by providing necessary medical treatment to recuperate from a work-related illness or injury and get compensated for the lost wages during the recovery phase.

It is important to inform about your work-related injury to your employer and file a worker compensation claim in time. Claiming such injuries might be daunting for many workers as they’re unaware of their rights, which is why it is crucial to work with an experienced personal injury attorney to know more about your case.

Workers Compensation 90 Day Rule

Workers Compensation Attorney

According to the worker’s compensation 90-day rule, employers have a legal duty to provide their employees with work-related injury insurance.

The employers are responsible for accepting or rejecting the claim within 90 days once the injured worker files the claim. They get automatically liable if they neglect or fail to accept the worker’s compensation claim before the deadline. This is referred to as the workers compensation 90 day rule.

Work-Related Injuries Covered

Workers compensation 90 day rule covers various work-related injuries or illnesses, including the following:

  • Slip and fall injuries
  • Hypertension
  • Stroke
  • Occupational exposure
  • Heart disease
  • Muscular issues
  • Depression
  • Cumulative trauma
  • Fatigue
  • Communicable diseases
  • Harassment

Important Time Frame To Claim Workers’ Compensation Benefits

Injury at the workplace

It is imperative to report your supervisor about your injury immediately, and this is because quick reporting can help minimize benefit delays.

On the other hand, if you have suffered an illness or injury that develops slowly due to the nature of your job, report it as soon as you notice it. Make sure to report within 30 days to retain your workers’ compensation benefits. However, the time frame may vary from one state to the other.

Further, once the employee files the claim, the employer should provide them with the workers’ compensation claim form, DWC-1, within 24 hours to begin the claims process.

Employees need to read all the information carefully, complete the form with detailed information about the injury, and sign it. From the submission of the claim form, the workers compensation 90 day rule kicks in.

Consequently, the employer must accept, reject or put off their decision regarding the work injury. For instance, if the employee files a workers’ compensation claim, the employer can either accept or reject the claim within 90 days.

However, during this period, injured workers are entitled to receive up to $10,000 worth of medical care from the employer. Alternatively, the employer is not required to cover temporary disability benefits for the income loss during the 90 days.

Hence, if the employee is away from work due to work injury and is covered with SDI ( State Disability Insurance) or some other disability policy, they must claim these benefits too.

If you’re unsure about your rights as an injured employee, you must discuss your case with an experienced personal injury attorney.

Workers’ Compensation System: A System Irrespective Of Any Inadequacies

Understanding the workers’ compensation system is crucial as it protects the employers instead of penalizing them.

In many cases, injured workers are legally not allowed to sue their employers in court following their workers’ compensation claim. Filing a workers’ compensation claim means giving up their legal right to pursue civil action against the employer.

It protects employers from suffering extravagant litigation costs whenever a worker initiates a work injury. Instead, employers must hold worker’s compensation insurance or legally be self-insured to help injured workers receive compensation benefits.

Getting Treatment From The Company’s Assigned Medical Provider Within 90 Days

an injured woman getting treatment in hospital

The most challenging part of beginning the workers’ compensation claim is to decide where and when to start getting medical treatment.

The employer must select the medical provider for the initial appointment. However, most injured workers misinterpret this information and think that they are bound to get treatment from the initial physician.

It is the employers’ responsibility to provide workers with information regarding the Medical Provider Network (MPN). This is a list of pre-approved physicians and doctors from which injured workers can select any approved medical provider for their treatment.

The MPN comprises a mix of specialized doctors in work-related injuries and the general field of medicine.

Generally, the employer must inform the worker about the MPN through a letter detailing the claim and the list of physicians from whom they can receive treatment. The injured worker can select a new physician after their initial appointment for further treatment.

Also, only some employers have an MPN. In such cases, the employer has the right to assign a doctor for an initial 30 days. After this period, injured workers can get treatment from a doctor who accepts the worker’s compensation insurance 30 days after the employer accepts the claim form.

What Happens If The Employer Does Not Follow The Law And Does Not Inform Workers About The MPN?

It is a fact that most employers do not comply with the laws by allowing the injured worker to select the doctor after the first appointment.

Despite this, most insurance companies and employers restrict injured workers from getting treatment from a particular doctor; otherwise, the insurance will not cover their medical expenses.

Such statements from employers are falsification of the workers compensation 90 day rule. According to this rule, the employer or insurance company does not have the right to instruct the injured worker for treatment with one medical provider or deny medical care payment if the worker does not follow their rules.

Unfortunately, due to this reason, many doctors also decline to provide treatment for injured workers because they believe that they will not get paid for their medical services under the workers compensation 90 day rule.

Let’s go over: how long can a workers comp claim stay open?

How Long Can A Workers Comp Claim Stay Open?

workers compensation claim

The answer to the question “how long can a workers comp claim stay open” is widely based on your state workers comp laws, including the workers’ comp insurance policy and the benefits you are entitled to.

Generally, medical treatment under worker compensation claims remains open for life. However, a worker comp claim ends once you accept or agree to a certain settlement.


Every injured victim must pursue a workers’ compensation claim to get the necessary medical treatment. Even for minor injuries, workers must pursue claims as these injuries can become medical complications later.

It is the employers, administrators, and worker compensation insurance companies’ utmost responsibility to establish an effective system to authorize an initial decision on all workers compensation 90 day rule claims.

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