Understanding your rights after an injury on the job in Pennsylvania can be challenging. PA’s workers’ compensation system has various rules employees must follow to be eligible for medical expense and wage loss benefits, and one of the most confusing is the “90-day rule.” This rule limits the healthcare providers that injured employees can seek treatment from during the first 90 days, as long as their employer meets specific requirements.
Understanding Pennsylvania’s 90-Day Rule
Under PA’s workers’ compensation law, the 90-day rule requires injured workers to receive treatment from an employer-designated healthcare provider. This requirement only lasts for the first 90 days after a workplace injury, and only if the employer has a properly posted list of approved medical providers for the employee to choose from.
This medical provider list must have at least six providers on it, and your employer cannot direct you to any one provider in particular. However, failure to receive treatment from one of the listed medical providers could result in the workers’ comp insurance company refusing payment.
Conditions for the 90-Day Rule to Apply
The three main conditions your employer must meet for their medical providers list to be valid are:
- The list must be posted clearly in the workplace for all employees and contain at least six approved healthcare providers, three of whom must be physicians.
- Employees must be informed about the list in writing when they are hired and when they report their work injury, and employees must acknowledge this by signing a written statement.
- The medical providers on the list must be geographically accessible to the injured workers, meaning not located an unreasonable distance away.
What Happens After 90 Days?
After the initial 90-day period expires, you can receive treatment from any healthcare provider of your choosing. However, you must notify your employer and their insurer of the provider from whom you wish to seek treatment.
Your employer’s insurer may also request medical treatment progress reports from your treating doctor. And they can request that you undergo an “independent medical examination” to determine the extent of your recovery. Despite the name, these examinations are not independent. They are for the insurer’s benefit.
Exceptions to the 90-Day Rule
There are several exceptions to the 90-day rule that it’s essential to be aware of before you begin seeking treatment with a doctor from your employer’s list:
- You can always seek emergency medical treatment from any healthcare provider.
- You can seek medical treatment from any provider if your employer failed to meet the conditions for a valid doctor’s list.
- You can seek specialist treatment from a provider not on your employer’s list if the list doesn’t contain a relevant specialist.
Why It’s Important To Follow the 90-Day Rule
Following the 90-day rule is important for your workers’ compensation case so that you can make sure that your employer’s insurer covers your medical treatment. Failing to follow this rule could result in you having to pay out-of-pocket for your treatment, which can get expensive quickly, especially if you have severe injuries.
The last thing you want after a work injury is to find out that you will be responsible for the cost of your medical treatment. And this is why it’s vital that you work with a workers’ compensation lawyer who can protect your rights.
Contact Our Pennsylvania Workers’ Comp Attorneys
If you were injured in a workplace accident in Pennsylvania, contact DelVecchio & Miller, LLC, for a free consultation with a knowledgeable and experienced workers’ compensation attorney. We’ll help you understand your rights and responsibilities under the Workers’ Compensation Act and assist you in seeking the compensation you need.