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How Long Am I Required to See the Company’s Doctor?

Law Office of Shabbick & Stehle May 17, 2023

The system of protecting employees on the job now known as workers’ compensation sprang into life in 1911 in Wisconsin. Nine other states followed before 1920. Today, nearly all 50 states have mandatory workers’ compensation laws in place.  

Workers’ compensation is a no-fault insurance program that pays employees for injuries suffered on the job or for illnesses deriving from workplace conditions, such as from the use of toxic chemicals. No fault means that an injured or ill employee cannot sue the employer, and likewise the employer cannot sue the employee. Workers’ compensation not only covers medical and rehabilitative expenses but also any lost wages due to the inability to perform one’s duties because of injury or illness related to work. 

The regulations for workers’ compensation vary from state to state. In Pennsylvania something called “the 90-day rule” pertains. What this means is that for the first 90 days after a work-related injury or illness, the employee must see a physician approved by the employer, or workers’ compensation doesn’t have to cover the expense. 

If you’ve been injured on the job or fallen ill due to workplace conditions in Bethlehem, Palmerton, or anywhere else in Pennsylvania, contact the legal team at Shabbick & Associates, PC. We have more than 40 years’ experience in dealing with workers’ compensation claims and we can help you navigate the system and file any appeals if necessary. We also proudly serve clients in the counties of Lehigh, Northampton, and Carbon. 

What is the 90-Day Rule?

Pennsylvania was among the early adopters of workers’ compensation legislation, passing the Workmen’s (now Workers’) Compensation Act in 1915. The act placed the Department of Labor & Industry and its Bureau of Workers’ Compensation in charge of overseeing and enforcing the legislation. 

With very few exceptions, the law requires all employers with one or more employees to offer workers’ compensation benefits. This can be done by contracting with an outside insurer, self-insuring, or through the State Workers’ Insurance Fund (SWIF). The latter is a state resource that is required to provide insurance to any business, even if they can’t purchase it through private insurers. 

The 90-day rule in Pennsylvania pertains to the physicians you can utilize when you are injured or fall ill because of workplace factors. Your employer has the right to post a list of “panel physicians,” at least six or more, whom you must use for the first 90 days following your injury or illness onset. If your employer does not post a list, you are free to see a physician of your choice, but otherwise, you must use one of the posted providers or your claim can be denied. 

You are free to choose any doctor on the list, but you must remain under the care of that physician for the first 90 days following your injury or illness. There is one exception, however, and that is if the doctor you visit recommends invasive surgery. In that case, you can receive a second opinion from a doctor of your choosing. However, if the surgery is to take place during the initial 90 days, then it must be done by a company-approved doctor. 

After 90 Days 

Once the 90 days have passed, you are free to choose your own physician, but you must inform your employer and your workers’ compensation insurance provider. You must also submit monthly reports from your doctor to certify your condition and the treatment you’re undergoing.  

The switch to your own physician, however, might not be as smooth as you anticipate. Both your employer and the insurer can request medical records, the completion of various forms, along with written evaluations from your doctor. Matters can get challenging. 

Independent Medical Examinations

At any point when you’re being treated for an injury or illness under workers’ compensation, your employer and/or the company’s insurance provider can request what is called an independent medical examination (IME). This means they are essentially getting a second opinion from a physician or medical group of their choosing.  

Though the word “independent” is emphasized, obviously the physician or group chosen will be on the payroll of the employer or insurance company. These independent medical examiners can be very quick to release workers to light duty for the employer’s benefit.  

If you get a request for an IME while out on workers’ compensation, be aware that this probably means your employer/insurer is looking to cut off your benefits. You should consult with an experienced workers’ compensation attorney before undergoing an IME. The attorney cannot intercede in the process but can advise you on how to prepare and handle everything. 

If the IME does end in a foreclosure of benefits, or a denial before you even get those benefits, your attorney can help you file an appeal with the Bureau of Workers’ Compensation. 

Strong and Effective Legal Advocacy

If you’ve been injured at work or fallen ill because of workplace conditions and wish to file a workers’ compensation claim—or worse, you’ve been denied benefits—contact us immediately at the Law Office of Shabbick & Stehle.

We know how the system operates and we can help you assemble the documents and evidence necessary to help your claim be approved, or to challenge an adverse decision. We serve clients in and around Bethlehem and Palmerton, and throughout the counties of Lehigh, Northhampton, and Carbon. Set up a consultation with our team today.