What is the Workers’ Compensation 90-Day Rule?


Cassandra Nguy

The workers’ compensation 90-day rule requires employees to report a work injury within 90 days to receive funding. The rule varies for each state, as some don’t have the rule at all, or have different variations you should know.

Some states like California follow a different 90-day rule that protects employees if their claim gets delayed. If California employers don’t respond within 90 days of delaying your claim, it will be approved and all payments related to your work injury are covered.

No matter the 90-day rule your state follows, you need a workers’ comp attorney to organize your claim while you’re recovering. If you are filing for workers’ compensation, find a workers’ comp attorney and learn the laws within your state.

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California’s Workers’ Comp 90-Day Rule

California’s workers’ comp 90-day rule discloses that after filing a claim, the company’s insurance must respond within 90 days of submission. The claim is automatically approved if your employer fails to respond.

California has an insurance-based deadline where insurers have 14 days from the claim to investigate and respond. If your employer delays your claim, they may send a ‘notice of delay’ within 90 days.

The workers’ compensation 90-day rule protects employees from excessive delays by automatically approving the following benefits once 90 days pass:

  • Medical Care. — Hospitalization, medical treatment, transportation, doctor’s appointments, and other medical care to recover from work-related injuries.
  • Temporary Disability. — When you can’t work for a time due to work-related injuries, you may seek temporary disability benefits to compensate for a portion of your lost wages.
  • Permanent Disability. — If an injury forces you to leave work permanently, seek permanent disability benefits to recover your lost income.
  • Supplemental Job Displacement Benefit (SJDB). — When your job lets you work in different job positions/careers, apply for a voucher to cover your education, training, and licensing program expenses.
  • Death Benefits. — If an employee passes due to a work injury, the descendent spouse, children, or any dependents can claim death benefits such as burial costs and weekly benefit payments.

Contact a workers’ comp attorney if you haven’t received a response within 90 days and have not received compensation. Each state’s 90-day rule is different, so an attorney in your state can help organize your workers’ comp claim.

Pennsylvania’s Workers’ Comp 90-Day Rule

In Pennsylvania, their 90-day rule states that injured employees must see a panel physician within 90 days of the incident to receive compensation. These panel physicians are a list of doctors approved by the employer. Workers’ comp benefits may not cover the cost if you want to choose your designated doctor during these 90 days.

Every state has regulations depending on the time and location to see a designated doctor. The time varies in each state; some take longer, and others are shorter before an injured employee can see a panel physician.

You have a right to know the rules and regulations of workers’ comp benefits. Finding a workers’ comp lawyer is recommended if you’d like to learn about the laws within your state.

How to Report Your Workers’ Comp Claim

In Pennsylvania, you must report your work-related injury or illness to your employer within 120 days. Waiting afterward may deny your claim or limit its benefits.

Once you report to your employer, you have to seek medical attention. Mention to your doctor that this was a work-related incident. In the first 90 days of the injury, you will choose a doctor from a list approved by your employer. They must submit a first report to the state to start the proceeding.

If your employer denies the claim or fails to act, the deadline is three years from the injury date. You’ll need to file a claim petition so you don’t lose your workers’ comp benefits. Otherwise, your employer or their insurance company will fill out workers’ compensation claim forms to the Pennsylvania Workers’ Comp Bureau.

Some states, like Arizona, take on a no-fault system in which employees receive medical and compensation no matter who’s at-fault during the job-related accident. You can’t file lawsuits against your employer unless under limited circumstances.

In Arizona, injured workers must submit a workers’ comp claim to the Industrial Commissions of Arizona (ICA) within one year from the injury date. File a claim for workers’ comp by filling out the Workers’ and Physician’s Report of Injury at the doctor’s office or requesting it at the ICA.

Every state has its laws and regulations on workers’ comp benefits. If you’d like to file a claim for workers’ comp, get to know the rules within your state by contacting a lawyer. LegalASAP is connected with hundreds of law firms across the United States and can get you in contact with a local lawyer within your state.

What Happens if I Fail to Report My Workers’ Comp Claim?

Failure to report your workers’ comp claim could deny or limit your workers’ comp benefits. For instance, in California, you must report your work-related injury to your employer within 30 days. If you fail to act before then, the company could deny your workers’ comp claim.

In Maryland, you must follow several statutes of limitations, preferably with an assistance of counsel. You must file within 60 days from the injury date and with medical release documents. The state may excuse the late filing if they find the reason was due to the employer’s prejudice.

Exceptions to the 90-Day Rule

In some states like California, the only exception to the 90-day rule is new evidence. California defines new evidence as these types of information:

  • New materials to the case
  • Unknown to the employer or claim administrator within 90 days
  • Not found by the employer or claims administrator

In other states like Massachusetts, there are certain exceptions and unique circumstances which could affect the 90-day rule.

Reasonable Cause

Some workers’ compensation cases in Massachusetts can extend as long as the injured worker can provide a valid reason. Reasons like medical incapacitation, unforeseen circumstances, or alternate compelling factors may warrant an extended period beyond 90 days.

Occupational disease or repeating trauma are exceptions to the 90-day rule. When injuries slowly develop over time through the results of repetitive tasks, the 90-day rule may change.

These exceptions apply in situations where the injured worker is not able to meet the standard reporting date.

Cumulative Injuries

Certain states allow for flexibility in the 90-day rule due to the unforeseen nature of some injuries. Injured workers may not realize the pain is caused by work-related tasks.

For instance, a stocker at a grocery store is often carrying heavy boxes daily, which slowly causes back pain. The worker may not think much of the pain, but over time it worsens and later requires medical attention. The countdown to the 90-day rule may not start unless the injury is seen as being work-related.

Find Out How the 90-Day Rule Applies to You With Your Attorney!

If you believe the 90-day rule applies to you, contact an attorney and find out. LegalASAP partners with 500+ law firms with thousands of attorneys across the United States. We can help you find a local workers’ comp attorney within your state who will help you file your claim.

Time is crucial when filing for workers’ comp, so fill out this short evaluation form, and we will contact you as soon as possible.

Cassandra Nguy

Cassandra Tran Nguy is a legal writer living in Los Angeles, California. She graduated cum laude from California State University, Northridge with a B.A. in English Creative Writing and a minor in Marketing. Visit her online profile at linkedin.com