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Workers' Compensation

How the “90-Day Rule” Can Affect You

By June 13, 2022June 28th, 2022No Comments

Medical evidence is key to proving and maintaining your Workers’ Compensation benefits. When you are injured at work, you should see a doctor as soon as possible after the injury. Be sure to provide a detailed, accurate history. If you have a claim for an occupational disease that you believe developed over time and from overuse, like carpal tunnel or hearing loss, your doctor will need to determine whether your injuries are related to your job. After diagnosing a condition, the Workers’ Compensation doctor will determine whether responsibilities and duties could have led to it.

You can see any doctor or medical provider that accepts Workers’ Compensation; you do not need a referral. However, in an emergency, you can be treated by any provider. When you are seen by a doctor, make sure that the doctor’s office is aware that they are treating you for your work-related injury. Bills for treatment should be sent to the workers’ compensation insurance carrier and not your private insurance. Medical treatment in workers’ compensation is covered in full, including prescriptions, so it is a red flag if a provider is asking you for a co-pay.

While you are out of work and receiving benefits at a temporary rate, it is vital that you see a doctor at least every 90 days. This is commonly called the “90-day rule” or the “Workers’ Compensation 90-day rule.” Your doctor must comment on your degree of disability in order to maintain your lost wage benefits. If you go longer than 90 days without seeing a doctor, your Workers’ Compensation carrier can seek to suspend these benefits.

If you are having difficulty finding an authorized provider, Lewis and Lewis can provide you with a list of doctors in the Western New York area who accept Workers’ Compensation patients. Additionally, the Workers’ Compensation Board maintains a searchable list of all providers, which can be found here. If you have questions about your claim, call us today at (716) 854-2100.

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