Quick Answer
In Pennsylvania, if you get hurt at work, you must see a doctor from your employer’s approved list for the first 90 days. If you don’t, your employer’s insurance won’t have to pay your medical bills.
After 90 days, you can switch to any doctor you want. It’s also important to report your injury to your employer as soon as possible, because waiting too long can affect the benefits you receive.
Getting hurt at work can turn your life upside down fast. One day, you’re gainfully employed and earning a wage that supports yourself and your dependents. Next, you’re dealing with pain, doctor’s appointments, and the stress of not knowing when you can return to work.
Although workers’ compensation exists to protect you during this time, understanding the rules can feel overwhelming. One of the most important rules is called the workers’ compensation 90-day rule. If you aren’t sure how it works, you could lose the workers’ compensation benefits you need by not reporting your workplace injury as soon as the injury occurred.
What Is the Workers’ Comp 90-Day Rule?
Many injured employees who report a workplace injury to their employer are surprised when their supervisor gives them a list of doctors they can see for treatment. They may be more surprised to learn that they are legally required to see a certain physician, sometimes referred to as a “panel doctor.”
The 90-day rule refers to seeking medical treatment after the first 90 days of your workplace injury. Under the Pennsylvania Workers’ Compensation Act, if your employer has properly established a list of approved medical providers, you are generally required to treat with one of those providers for the first 90 days after your work injury.
During that initial 90-day period, your employer and their insurance company have the right to direct your medical care, provided they follow the rules for setting up the panel. After 90 days have passed, you are usually free to seek treatment from a doctor of your own choosing, and workers’ compensation should still cover that treatment.
Deadlines vs. 90-Day Rule for Reporting a Workplace Injury
Many people confuse the 90-day rule with injury reporting deadlines, which are a completely separate part of Pennsylvania workers’ compensation law. Reporting deadlines refer to how soon you need to notify your employer that you were hurt at work, while the 90-day rule controls who provides your medical treatment early in the workers’ compensation case.
In Pennsylvania, injured workers generally have up to 120 days to report a workplace injury, but waiting more than 21 days can affect when wage loss benefits begin. These deadlines deal with notice and pay, not doctors, and misunderstanding the difference between the two can lead to serious problems with a workers’ compensation claim.
What Is a “Panel Doctor,” Exactly?
A panel doctor is a medical provider chosen by your employer. Pennsylvania workers’ compensation law allows employers to control initial treatment if they meet specific filing requirements. Normally, a list of approved panel doctors will be given to you after you report a workplace injury, but Pennsylvania law also requires the list of panel doctors to be properly posted in the workplace and include more than one provider and several specialties.
If your employer does not properly post the list, they can lose control of your medical care even if it is still within the first 90-day window.
Why the 90-Day Rule Matters So Much in Cases Involving Workers’ Compensation Benefits
When you’re hurt and out of work, medical records can make or break your workers’ compensation claim. The doctor you see will be the person documenting your workplace injury and how it is work-related. They’ll also make decisions about whether or not your injury prevents you from working. This information is foundational for your entire workers’ compensation claim.
As such, it’s important to remember that panel doctors are not necessarily bad doctors, but they are chosen by the employer. In some workers’ compensation cases, injured workers feel rushed back to work or feel their pain is minimized. However, if you refuse to be treated by your employer’s panel doctor, you could lose your right to workers’ compensation benefits.
What Happens After 90 Days?
After 90 days, you are generally permitted to treat with any doctor you choose. To switch doctors, you’ll need to provide the new doctor with the insurance carrier’s information and the claim number so they can be properly billed for your treatment.
Should You Ignore the 90-Day Rule?
Not if you want workers’ compensation to pay for your medical bills. Technically, you can go to any doctor you’d like to have your workplace injury treated, but your employer’s insurance carrier doesn’t have to pay for treatment from a physician who is not on their panel during the first 90 days.
It’s also important to remember that your personal insurance will likely not pay for your care if your injury is work-related.
How Much Is Your Case Worth?
Should I Hire an Attorney to Help with My Workers’ Compensation Claim?
Workplace injuries can sideline you for weeks or months, or even leave you permanently disabled. Unfortunately, your employer’s insurance carrier is looking out for its bottom line, not your best interests. Although you should report your injury as soon as possible and see a panel doctor in the first 90 days, hiring an experienced workers’ compensation attorney can help protect your rights and make the workers’ compensation claims process less stressful.
Talk to Pond Lehocky for Help with Your Disability Benefits and Understanding Your Legal Rights
At Pond Lehocky, we aim to help injured workers get the compensation they need to cover their expenses while they are unable to work. If you’ve been injured while on the job, contact us today to find out how we can help you with filing a workers’ compensation claim and what your legal rights are under the law.
