What is the Pennsylvania Workers’ Comp 90-Day Rule?

Dealing with a workplace injury can be stressful and tiresome. It can be hard to keep your composure while medical bills and lost wages pile up. Still, certain procedures must be followed in order to obtain the Workers’ Compensation benefits you are owed.

In Pennsylvania, the 90-day rule mandates that you initially seek medical treatment from designated panel physicians for the first three months following your on-the-job injury. Failure to do so may result in the denial of Workers’ Compensation benefits. However, after this 90-day period has ended, you will have the flexibility to choose your own medical provider.

If you were hurt at work, seek guidance from our Certified Pennsylvania Workers’ Compensation lawyers at Cardamone Law by dialing (267) 651-7945.

The 90-Day Rule for Workers’ Compensation Claimants in Pennsylvania

In Pennsylvania, there are specific regulations governing how injured employees can access medical treatment following a workplace accident. It is crucial to understand that seeking treatment from the appropriate healthcare providers is essential to ensure coverage for medical costs.

Pennsylvania’s regulations include what is commonly known as the “90-day rule” under § 306 of our state’s Workers’ Compensation Act. According to this rule, an employer who chooses a list of panel physicians must conspicuously display the list in an easily accessible area within their workplace. In turn, the employer can enforce a policy mandating that their employees seek medical attention from one of the designated panel physicians for the first 90 days following their workplace injuries.

Suppose your employer chooses a list of panel physicians, and you visit your own doctor within the first 90 days after an on-the-job injury. In that case, the medical bills stemming from that visit may not be covered by Workers’ Compensation. However, once this 90-day period ends, you are no longer required to continue seeing your employer’s doctors. You and your Pennsylvania Workers’ Compensation lawyer will then have the freedom to choose any healthcare provider to receive treatment.

It is important to note that if you need specialized treatment like surgery during the first 90 days after a work-related injury, then you have the right to seek a second opinion from a doctor of your choice. If this second opinion suggests a different treatment plan, you can decide which one to follow. Still, you must make sure the second opinion provides clear details about the recommended treatment. If you opt for the treatment from the second opinion, it must be performed by a doctor approved by your employer for the next ninety days.

Who Can Be Included on an Employer’s List of Panel Physicians in Pennsylvania?

Under the 90-day rule, an employer’s list of panel physicians must include at least six designated healthcare providers. Among these providers, no more than four may be a coordinated care organization, and no fewer than three must be physicians. It is important to note that the employer is prohibited from including any healthcare provider or physician owned, employed, or controlled by the employer or their insurance company unless such a relationship is disclosed on the list. This ensures transparency and impartiality in the selection of healthcare providers for injured employees seeking medical treatment under Workers’ Compensation.

An employer has the discretion to modify their list of panel physicians. However, any changes made must still adhere to the aforementioned requirements.

Differences Between Panel Physicians and Personal Healthcare Providers in Pennsylvania

As mentioned, panel physicians are healthcare providers chosen by your employer’s insurer to offer medical treatment for the first 90 days after a work-related injury.

In terms of treatment, panel physicians are often focused on providing immediate care to address the harm you suffered. Their approach may prioritize getting you back to work as soon as possible while ensuring that your treatment is within the scope of Workers’ Compensation guidelines. However, panel physicians may fail to recognize the true extent of your on-job injury. For instance, they may designate a particular injury as a minor sprain, when you are actually suffering from a more serious issue.

Your personal healthcare providers, however, may have a more comprehensive understanding of your medical history, pre-existing conditions, and overall healthcare needs. Their treatment approach may be more holistic, as they consider not only the immediate injury but also its potential long-term impacts on your health and well-being. They may advocate for your best interests, even if it means challenging decisions made by your panel physicians.

What Else Must an Employer Provide Besides Medical Services Under the 90-Day Rule in Pennsylvania?

In addition to covering medical services and physician consultations, employers are obligated to provide payment for a range of additional necessities. This includes compensation for medicines, supplies, hospital treatment, and orthopedic appliances as deemed necessary by the attending physician. Furthermore, in cases where an employee has experienced the loss of a limb, part of a limb, or an eye because of a workplace injury, the employer is required to pay for an appropriate artificial limb, eye, or other prostheses recommended by the attending doctor.

What to Do if You Were Denied Workers’ Compensation Benefits Under the 90-Day Rule in Pennsylvania

If you have been denied Workers’ Compensation benefits under the 90-day rule, you must take immediate action to protect your rights. The first step is to contact our legal team as quickly as possible. We will review your denial notice thoroughly to understand the reasons behind the denial and assess the strength of your claim.

Next, we will work with you to gather all necessary evidence to support your claim. This may include medical documents, witness statements, and communication records. Simply put, we will collect any and all information that may help us build a strong case to challenge your denial and advocate for your rights.

Finally, if it is determined that you have grounds for an appeal, then our legal professionals will guide you through the appeals process. We will ensure all deadlines are met and all necessary paperwork is filed correctly to give your appeal the best chance of success.

Call Our Law Firm for Assistance with Your Workers’ Compensation Claim in Pennsylvania

If you sustained a work-related injury, get support from our Certified Philadelphia Workers’ Compensation attorneys by calling Cardamone Law today at (267) 651-7945.