The Workers’ Compensation 90-Day Rule: What Is It and Can It Affect My Case?

Hour glass on calendar concept for time slipping away for important appointment date, schedule and deadline for workers' compensation claim for injured workers that need medical treatment When it comes to workers’ compensation benefits, an employer’s insurance company is generally responsible for the cost of medical treatment and financial losses of an injured worker.

Additionally, because workers’ compensation is a no-fault system, injured workers do not need to prove another party’s negligence in order to receive workers’ compensation benefits.

While the process for filing a workers’ compensation claim form should be straightforward, injured workers may run into issues with the insurance company that can delay receiving benefits for months.

If you suffered a work injury, make sure you are aware of California’s workers’ compensation laws pertaining to the 90-Day Rule.


What Is the Workers’ Compensation 90-Day Rule?

Like many laws, the rules and regulations that govern a work injury vary from state to state, meaning the workers’ comp 90-day rule will not always mean the same thing. So, be sure to familiarize yourself with the workers’ comp claim process in the state where the work-related injury occurred.

For instance, the “rule” in Pennsylvania pertains to a select list of panel physicians that injured workers can seek medical treatment from within the first 90 days following the accident. Whereas, California’s rule allows the workers’ compensation insurance carrier to delay responding to a claim for up to a 90-day period.

Therefore, if the accident occurred in San Jose, then it would fall under California’s workers’ compensation law. Generally, the rule states that an employee must report a work-related injury or illness to the employer in order to qualify for workers’ compensation benefits. Then, the employer has 90 days to review and respond to the claim.

Workers’ Compensation Law + Third-Party Involvement

Even if the employer is not necessarily “negligent” for the accident, a workers’ compensation claim form must still be filled out. In some cases, it is possible to file a workers’ comp claim and a personal injury claim for the same workplace injury. This is referred to as “double recovery.” 

For example, if an employee was running errands for their employer and was struck by a reckless driver in the process, the employee could qualify for workers’ compensation benefits and may be able to file a personal injury claim against the driver, as well.

While additional damages can still be recovered through a personal injury lawsuit, a workers’ comp claim should always be filed when an accident occurs on company time while performing work duties. 


How the Workers’ Compensation 90-Day Rule Works in California

Filling Worker Compensation After Injury Application FormIn California, the 90-day rule pertains to the response time from the workers’ compensation insurance. After a workers’ compensation claim is filed, the insurance company has 14 days from the filing date to respond. 

If the employer chooses to delay, they are allotted 90 days to review a case and come to a decision on providing benefits or denying the claim. During this time, the employer must provide the employee with up to $10,000 in medical care, but they are not obligated to pay for lost wages. 

However, once the 90-day period passes, the workers’ comp claim is automatically deemed accepted, which can cover medical bills, lost wages, and other costs related to the work injury.  


What Qualifies as a Work Comp Injury?

The workers’ compensation system is meant to protect employees by providing them with the necessary medical treatment and compensation following a work-related accident. The system covers a range of injuries and illnesses, including the following:

  • Back Injury
  • Bone breaks or fractures
  • Burns
  • Chemical exposure
  • Disease
  • Head injury
  • Neck injury
  • Repetitive stress injury
  • Soft tissue injury
  • Sprains
  • Traumatic brain injury (TBI)


Benefits Injured Workers Can Claim

Close up Wheelchairs waiting of patient services. Medical Wheelchairs in the hospital while patient discussing temporary disability benefits and permanent disability benefits for a workers' compensation claim Because workers’ compensation benefits cover a wide range of injuries and illnesses, the expenses to treat and/or compensate employees will vary, as well. Some examples of workers’ compensation benefits that can be claimed in California include: 

  • Death Benefits: Payments to surviving family members
  • Medical treatment: Consists of hospital visits, ambulance transport, doctor appointments, physical therapy, or other medical care required to recover
  • Permanent disability (PD): Permanent disability benefits replace wages that cannot be earned due to injury based on a calculated percentage to measure the disability
  • Temporary disability (TD): Temporary disability benefits replace a portion of lost income while on leave to recover from injury
  • Supplemental job displacement benefits: A voucher to cover the cost of education or training for a new career when unable to return to the previous type of work


What to Do if a Claim Is Delayed or Denied

punitive damagesIf a workplace accident is severe, the workers’ compensation claim may take longer to review; it may even be denied.

Other times, the case requires an extended review period due to its complexity. For instance, injuries that worsen with time and were not sustained from a single instance, like repetitive motion injury or exposure, will likely require a longer investigation and review. 

Regardless, the longest an employer’s workers’ compensation insurance carrier can delay a decision is 90 days. Injured employees who have not been updated on their cases can always consult with a San Jose workers’ compensation attorney

Additionally, if a claim is denied, attorneys can assist with appealing the decision through the California Department of Industrial Relations. 

An established law firm with experience dealing with workers’ compensation insurance can help injured workers make smart and informed decisions during the legal proceedings, ensuring they get the benefits they are entitled to. 


Do You Need Help Filing a Workers Compensation Claim?

Employees who were injured while at work should report the event as soon as possible. In many workers’ compensation cases, there is a filing deadline, and proving the legitimacy of a workplace injury will be more difficult the longer it goes unreported.

If you have questions about the filing process, have already filed a claim but have not received benefits, or have any other concerns regarding your workers’ compensation case, an experienced San Jose workers’ comp attorney can assist.

At Valley Accident Attorneys, our dedicated legal team has helped countless clients successfully settle their claims for maximum compensation. To discuss your case, please schedule a free consultation.

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