Workers’ Compensation 90-Day Rule: How Does It Work? 2024

Workers’ Compensation Deadlines

Every state has a workers’ compensation system, and each of those systems has a unique set of rules. These rules include deadlines for action by both the worker and the insurer. When a party misses these deadlines, they risk receiving an adverse finding or action. A worker might lose their claim, while an insurer may lose its right to contest a claim.

Most states impose some or all of the following deadlines:

• Reporting an injury or illness to the employer

• Notifying the workers’ comp insurer of the claim

• Sending the claim forms to the injured worker

• Filing a claim with the insurer

• Deciding whether to accept or deny the claim

• Seeking treatment for the injury

Workers’ compensation systems also set two additional time limits. First, most states impose a waiting period for workers before they can receive disability payments. For example, Wyoming does not pay disability payments to workers unless their injury keeps them out of work for at least three days.

Second, some states cap the time workers can receive disability payments. The same Wyoming statute that sets a three-day waiting period also limits temporary disability payments to 24 months. If the worker’s injury is permanent, Wyoming allows up to 80 total months of temporary and permanent disability payments. To avoid paying disability benefits for over six years, insurers may pay a lump sum workers’ comp settlement.

The term “workers’ compensation 90-day rule” refers to a 90-day deadline some states impose for certain actions. However, the states do not apply the 90-day deadline uniformly, so you must look at each state’s rules to identify which actions must occur within 90 days.

How to Satisfy the 90-Day Rule

Since every state has a different set of deadlines, the workers' compensation 90-day rule has a different meaning depending on the worker’s state. As a result, complying with the 90-day rule could require different actions at different stages in the process in each state. Your case might include any of the following 90-day deadlines:

Notifying Your Employer of Your Injury

Every state requires you to notify your employer of an on-the-job injury or occupational illness. You can ask someone else to contact the company if the severity of your injuries prevents you from providing notification. For example, you can ask a coworker to notify your supervisor as you leave your workplace in an ambulance. Your co-worker’s notification will satisfy the requirement.

Keep in mind that your notice does not need to appear in writing. Oral notifications are usually acceptable. Similarly, the notification does not need to take any specific form. Simply telling your employer that you got hurt and need to visit a hospital typically satisfies your requirement.

In some situations, your employer has constructive notice of your injury. Thus, you probably do not need to provide notice if your supervisor saw your accident.

If you suffered an occupational illness, the time to report it begins on the day you discovered the connection between your medical condition and your work. Occupational illnesses result from something in your work environment. Examples of these illnesses include:

• Repetitive stress injuries, like carpal tunnel

• Hearing loss

• Cancer or lung disease from toxic chemical exposure

Some states require this notification to happen within 90 days. In these states, you must report your condition to your employer within 90 days of your injury or occupational illness diagnosis.

States with this notification rule include the following:

• Delaware

• Iowa

• Michigan

• Oregon

• South Carolina

These states allow the insurer to deny benefits if the worker misses the deadline for an unexcused reason.

Filing a Claim

States differ on whether they require the worker to file a claim. Some states, such as Illinois, require the employer to file a claim for the worker. Other states, require the worker to file a notice with the state workers’ compensation board. Still, other states require workers to file claims directly with the workers’ comp insurer.

Only one state has a workers’ compensation 90-day rule for filing a claim. In Nevada, workers only have 90 days after their injuries to have a doctor sign a claim document and send it to the employer and its insurer.

Seeing an Approved Doctor for Treatment

Most states require the worker to obtain a diagnosis. They differ on who can render the diagnosis, though. Some states allow the worker to choose any doctor. Other states allow the insurer and employer to limit the worker’s choices.

In Pennsylvania, for example, the employer or insurer creates a physicians list and posts it in the workplace. Workers must choose a doctor on the physicians list when they get hurt at work.

Workers are limited to this doctor for 90 days after the first doctor’s visit. The insurer does not need to pay for treatment or therapy obtained from an unlisted doctor during that period.

Approving or Denying a Claim

Workers’ comp insurers can deny claims for various reasons, such as:

• The injury did not occur while working

• The employee’s intoxication caused the injury

• The injury was related to a pre-existing condition

Insurers sometimes delay claims to frustrate the worker into withdrawing it. In California, insurers cannot use this tactic. An insurer is presumed to accept the claim if it does not deny it within 90 days. In other words, insurers only have 90 days to deny a claim before automatically accepting it.

Learn More About Workers’ Comp Deadlines From ConsumerShield

Workers’ compensation procedures differ from those in almost every other field of law. After you suffer an injury at work, we can help you understand your rights and connect you with a lawyer who can help you. Contact ConsumerShield for your free case evaluation today.