Expertly Reviewed By: Serah Waweru, Esq., on April 12, 2023
When you search for information about the workers’ compensation 90-day rule online, you’re likely to come across many resources, including this article. However, this aspect of workers’ compensation can be more confusing than enlightening – at least until now.
But what exactly is the 90-day rule for workers’ compensation, and who is subject to it?
There is a wealth of information regarding this rule, but what’s most critical is to understand that its application varies depending on your location. In other words, Texas workers’ compensation guidelines may not be the same as those in Wisconsin, Oregon, New York, or any other state.
Therefore, it’s crucial to understand the different circumstances in which this rule comes into effect. Armed with this knowledge, you’ll find navigating the laws surrounding workers’ compensation in your particular state less daunting.
Let’s examine a few examples.
What the Workers’ Compensation 90-Day Rule Actually Means Different States
Pennsylvania has a workers’ compensation 90-day rule for seeking medical care after a work-related injury. This rule requires injured workers to see the appropriate doctor to have their medical bills paid by their employer’s workers’ compensation insurance carrier. If a worker sees a different doctor within this timeframe, the employer’s insurance provider may not cover their treatment costs.
Employers in Pennsylvania must post a list of “panel physicians” in a visible location in the workplace for workers. They must also require injured employees to initially seek treatment from one of these doctors. In addition, workers must be aware of this requirement and confirm their knowledge of it when hired and after an injury occurs.
After 90 days, workers are not obligated to see a panel physician. They may choose any licensed medical care provider as long as the treatment is necessary and related to the work injury.
Eligible workers in Arizona, Colorado, and Maine are also free to choose their own physician after a work-related injury. However, workers should be aware of the applicable rules in their state to avoid seeing the wrong physician and risking their coverage.
In California, the Workers’ Compensation 90 Day Rule is different from other states.
Here’s how California workers’ compensation 90 day rule works.
Once a work injury claim form is submitted, workers’ comp insurers have 14 days to respond. Employers may delay a claim decision, but if they choose to do so, they must provide up to $10,000 in medical care but not pay temporary wage loss benefits.
Employers in California have 90 days to review and respond to delayed claims. If more than 90 days elapse, the claim is accepted, and the employer should cover eligible expenses related to the work injury, including medical bills and lost wages.
In Nevada, the 90-day rule dictates that injured workers must fill out Form C-4 and have it signed and dated by a medical provider within 90 days of the injury or discovery. Failure to do so could jeopardize the workers’ chances of receiving workers’ compensation benefits.
The Workers’ Compensation 90-Day Rule Could Mean Something Different to Your Employer
Most work related injuries targeting the back, knees, and shoulders usually heal within 90 days. So, in most cases, employers will conduct further investigations if an injured worker has not returned to work or made progress in recovery by then.
Additional diagnostic testing, such as Magnetic Resonance Imaging (MRI) may be required to identify the possibility of more severe injuries. Employers may also conduct additional investigations to determine whether the worker is faking or exaggerating the injury.
We’ve answered more questions about the 90-day rule and workers’ compensation in general.
How Long Do Workers’ Comp Benefits Last?
The duration of workers’ compensation benefits varies by state and the severity of the injury. That said, benefits may last for a limited or indefinite period.
Temporary disability benefits are available to injured workers who cannot work due to a work-related injury or illness for a limited period. The duration varies by state but is typically a few weeks or months. These benefits may be extended if the worker’s condition requires more treatment.
On the other hand, permanent disability benefits may be available if the injury or illness results in a permanent impairment that prevents the worker from returning to their previous job. Similarly, the amount and duration of benefits vary by state and the severity of the injury.
Keep in mind that workers’ compensation benefits may be terminated if the worker reaches Maximum Medical Improvement or can return to work in some capacity. However, injured workers may be entitled to ongoing benefits, such as medical treatment, vocational rehabilitation, or other compensation.
How Long Can You Be on Workers’ Comp in California?
The duration of workers’ compensation benefits for a worker in California depends on the severity of their injury or illness. Temporary disability benefits can be received for up to 104 weeks (two years) within a five-year period. Additional benefits may be available if the worker’s condition has not improved after 104 weeks.
⚖️ PRO TIP: Severe injuries, such as lung diseases and serious burns, may warrant compensation of up to 240 weeks (4.6 years).
Permanent disability benefits may be provided to workers with permanent injuries or illnesses that prevent them from working. The amount and duration of these benefits are determined by the severity of the injury or illness, the worker’s age, occupation, and earnings prior to the injury or illness.
Supplemental job displacement benefits may also be available, providing up to $6,000 for retraining and skill enhancement. These benefits must be used for educational or vocational training-related expenses.
⚖️ PRO TIP: Workers’ compensation benefits in California are subject to review and modification, and benefits may end if the worker’s condition improves or they can return to work.
Why Would You Have To Pay Back Workers Comp?
You may need to repay workers’ compensation benefits when you receive other forms of compensation for the same injury or illness, a process known as ‘subrogation.’ For instance, let’s say you receive a settlement or judgment in a personal injury lawsuit related to your work-related injury or illness. In that case, you may have to repay the workers’ compensation benefits you received.
So, how is it possible to receive workers’ comp and personal injury compensation simultaneously and for the same injury? Here’s a hypothetical example.
John works as a delivery driver for Company X. While delivering materials to Company Y, he accidentally runs over Paul, who works at Company Y. The incident occurred when Paul was on shift at Company Y.
In that case, Paul can file a personal injury claim with John’s auto insurance provider. And since the incident occurred in the workplace, Paul may still be able to file a workers’ compensation claim with his employer.
Similarly, if you receive disability benefits like Social Security Disability Insurance (SSDI) or other disability benefits, your workers’ compensation benefits may be reduced or offset to prevent “double-dipping.” This means that if the combined total of your workers’ compensation and disability benefits exceeds a certain amount, your workers’ compensation benefits may be lowered.
Furthermore, if you return to work and earn an income, your workers’ compensation benefits may also be reduced or stopped based on the extent of your disability and the income you earn.
The whole point of subrogation, which is often controversial, is to prevent you from getting paid ‘more than what you deserve.’
Does Workers Comp Pay Full Salary?
Workers’ compensation benefits usually do not cover the full salary of an injured worker. Instead, they provide a portion of the worker’s pre-injury wages, usually a percentage up to a maximum amount set by the state. The percentage and maximum amount vary by state.
For instance, in Washington, the compensation is usually 60 to 75 percent of your regular paycheck.
In most cases, temporary disability benefits cover around two-thirds of the worker’s pre-injury wages, subject to weekly benefit caps. That said, the percentage of wages covered by permanent disability benefits depends on the severity of the injury and other factors.
What Is the Workers Comp Statute of Limitations?
The workers’ compensation statute of limitations refers to the time limit for a worker to file a claim for benefits after suffering a work-related injury or illness. The time limit varies by state and ranges from a few months to several years after the injury or illness. Some states may also consider other factors, such as when the worker discovered the injury, when the employer was notified, or when benefits were last paid.
Nevada has one of the shortest statutes of limitations for workers’ compensation injuries (90 days from the injury date or discovery), followed by Kansas (200 days from the injury date or discovery).
⚖️ PRO TIP: To avoid missing out on potential compensation, it’s important to know the statute of limitations in your state and file a claim for benefits as soon as possible after a work-related injury or illness.
What Are You Allowed To Do While on Workers’ Comp?
While receiving workers’ compensation benefits, you can obtain medical treatment for your injury or illness. You may also qualify for disability benefits to compensate for lost wages. However, there may be specific limitations or restrictions on your activities while on workers’ comp. These restrictions are in place to ensure that you do not aggravate your injury or illness or engage in activities that could hinder your recovery.
For instance, you may not be allowed to perform certain physical tasks, like heavy lifting or operating machinery. You may also be required to attend medical appointments and adhere to your healthcare provider’s treatment plan.
⚖️ PRO TIP: It’s crucial to comprehend and comply with these limitations and restrictions to avoid jeopardizing your benefits.
Can You Collect Workers Comp After Being Fired?
In certain situations, workers’ compensation benefits can still be collected even if an employee has been fired. The no-fault system of workers’ compensation means that it does not matter who was at fault for the injury or illness. As long as it can be demonstrated that the injury or illness was work-related and happened during employment, there may be eligibility for benefits.
⚖️ PRO TIP: Collecting workers’ compensation benefits after being fired can be complicated. It is, therefore, advisable to seek guidance from a knowledgeable workers’ compensation attorney to learn more about your rights and options.
Does Workers Comp Pay for Time Off?
Workers’ compensation does pay for time off work resulting from a work-related injury or illness. Suppose a worker cannot work due to injury or illness. In that case, they may be eligible for temporary disability benefits that can provide a portion of their pre-injury wages to cover their lost income during their recovery period. Additionally, if the injury or illness results in a permanent disability that prevents the worker from returning to their previous job, they may be eligible for permanent disability benefits that provide ongoing income support.
If I Sue Workers’ Comp Will I Lose My Job?
Not really. Workers’ compensation laws generally prohibit employers from retaliating against employees who file claims for benefits, including lawsuits. So if your employer retaliates against you for exercising your right to file a workers’ compensation claim, you may have a case against them.
How Long Will Workers’ Comp Pay for Physical Therapy?
The timeline varies depending on the circumstances of each case. Typically, workers’ compensation will cover physical therapy required for treating a work-related injury or illness until the injured worker has reached maximum medical improvement (MMI),
The length of time for physical therapy will depend on factors such as the severity of the injury, the required treatment, and the injured worker’s progress.
⚖️ PRO TIP: After a workplace injury, you should consult your healthcare provider and workers’ compensation claims administrator to receive the proper physical therapy treatment you need.
Is Workers Comp Taxable in California?
Individuals who receive workers’ compensation benefits in California do not have to pay state or federal income taxes on these benefits. However, there are exceptions to this rule.
A good example of a scenario where such exceptions apply is when an individual receives Social Security Disability Insurance (SSDI) benefits on top of their workers’ comp benefits. In this case, part of their workers’ comp benefits may be taxable.
Does Age Affect Workers Comp Settlement?
Age can influence workers’ compensation settlements, but it is not the sole factor. Typically, settlements are based on the following key factors:
- the injury’s severity;
- the type of work performed by the injured worker; and
- how long they will be unable to work or restricted in their ability to work due to the injury.
However, age may be considered if the injured worker is nearing retirement age and may have limited job opportunities or are already retired and unable to work. In such cases, the settlement may factor in the injured worker’s reduced earning potential and the impact of the injury on their retirement or pension benefits.
Employee Hurt on the Job No Workers Comp – What Happens?
If an employee is injured while working and the employer does not have workers’ compensation insurance, the employee may have the option to sue the employer for damages. In most states, employers are required to have workers’ compensation insurance. Failure to have this insurance puts the employer at risk of hefty penalties or fines.
⚖️ PRO TIP: Texas is the only state that does not require most employers to have workers’ compensation insurance.
When Does Workers Comp Start Paying?
Workers’ compensation payments schedule depend on state laws and that particular incident. In most cases, once the worker informs their employer about the injury and files a workers’ compensation claim, the employer’s workers’ compensation insurance provider will investigate the claim to determine its validity and the benefits the worker may be entitled to. Once approved, the worker will begin to receive their benefits. However, remember that your state may have waiting periods or other regulations that could affect the payment schedule.
In certain states, the workers’ compensation system mandates that employees who sustain work-related injuries must notify their employer within 90 days of the incident to be eligible for benefits. Failure to adhere to this rule can lead to a denial of benefits. As a result, workers must be aware of and follow this regulation to safeguard their rights and guarantee they receive the compensation they are entitled to.
However, as mentioned earlier, the workers’ compensation 90-day rule may have a different meaning depending on the state where the injury occurred. Also, bear in mind that some states may not even have this rule at all.
But you shouldn’t assume anything; speaking with an experienced workers’ compensation attorney is the best way to determine whether there is a 90-day rule in your state and how it applies to your situation.