04.25.2018

What Medical Treatment Does Workers Comp Not Cover? The 90-Day Rule

The workers’ compensation system in Pennsylvania was created for the benefit of injured workers who have important rights when injured in the workplace. Powell Law will protect working individuals when they incur a work-injury by helping them obtain all of the benefits to which they are entitled. For 112 years, our attorneys have represented all types of workers in workers’ compensation cases.

A common question related to workers’ compensation in Pennsylvania relates to what medical treatment is not covered by workers’ compensation insurance. When does a worker run the risk of not receiving medical benefits for some visit to the doctor?

Typically, an injured worker’s violation of Pennsylvania’s “90-day rule” provides an example of a circumstance where an insurance carrier will not be legally required to pay for a worker’s medical treatment. The “90-day rule” requires an injured worker to utilize certain, specific physicians for treatment within the first 90 days following the occurrence of the work-related injury.

Employers must conspicuously post a list of eligible “panel physicians” who an employee may see for treatment. If within the first 90 days after the injury, an employee receives treatment from a doctor who is not on the panel list, the workers’ compensation insurance carrier may legally refuse to pay the expense of such treatment.

The 90-day rule does not prohibit a worker from seeing a physician of personal choice, it only affects an insurance carrier’s obligation to pay for treatment provided by a non-panel physician. Injured workers may still see their own doctor and in doing so will not jeopardize the payment of future benefits related to their workers’ compensation claim.

Once an injured worker’s claim is accepted by the insurance company, he may treat with any doctor after the initial 90 days. An injured worker may also treat with a doctor of personal choice if an employer fails to satisfy its requirements of posting the list of panel physicians and obtaining employee signatures as acknowledgement of the 90-day rule.

Many injured employees, typically acting without the representation of an experienced workers’ compensation attorney, continue to believe that they are obligated to continue treatment with panel physicians after this initial 90-day period. Thus, as it presently stands, the 90-day rule clearly is frequently misunderstood by both injured workers and employers. An experienced Pennsylvania workers’ compensation attorney may help any injured worker act within the requirements of the “90-day rule.”

Since James Powell, Sr., founded Powell Law, our attorneys have represented all types of workers in workers’ compensation cases for 112 years since 1906. Our decades of experience make us the clear and obvious choice for representation in workers’ compensation matters in the Scranton/Wilkes-Barre and surrounding areas. At Powell Law, we effectively assist clients throughout the entire workers’ compensation claims process. Contact Powell Law at (570) 961-0777. The consultation is FREE!

What Medical Treatment Does Workers Comp Not Cover? The 90-Day Rule

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