The Myth of the 90 Day Rule - Why Injured Workers in Pennsylvania Almost Never Have to Treat With the Company Doctor

The constant mantra that injured workers in Pennsylvania must treat with a "company doctor" for 90 days, or they won't receive their workers' compensation benefits, is a myth, albeit one that many attorneys who represent injured workers erroneously accept as gospel. This podcast, by Pennsylvania workers' compensation attorney Daniel J. Siegel, shreds the myth that injured workers are required to treat with a designated physician, often called the company doctor.

Attorney Daniel J. Siegel explains why, under  Section 306(f.1)(1)(i) of the Pennsylvania Workers' Compensation Act, injured workers, often called claimants, rarely, if ever, are required to go to comp clinics or company doctors. The law says that before any injured worker must treat with any employer-designated medical provider, the employer must "provide a clearly written notification" of the employee's rights and duties to the employee, and ... obtain a "written acknowledgment" by the employee that they have been advised of the requirement. Verbal notice alone is inadequate. In fact, the Bureau of Workers' Compensation in Pennsylvania created its own form, "Notice: Medical Treatment for Your Work Injury or Occupational Illness," to dispel the myth.

In reality, most employers do not comply with this section of the Act; most injured workers do not have to treat with the so-called company doctor following a work injury. Despite this, many employers and insurance companies routinely tell injured employees they must go to a particular doctor or clinic, or the insurance company will not pay for their medical care. These statements are actually misrepresentations of the Workers' Compensation Act, which never gives an employer or insurance company the right to (1) mandate that an injured worker treat with only one provider or (2) "pre-deny" payment for care under most circumstances. Sadly, based upon the "90-Day Rule," many doctors refuse to treat injured workers for 90 days after their injuries because they have heard or been told that they will not be paid for any care they provide because of the "90-Day Rule."

This podcast tells you the truth about the law from an attorney with a nearly 40-year track record of representing injured workers and winning case after case in the Pennsylvania Supreme Court. These cases have protected the rights of injured workers. Dan's firm, the Law Offices of Daniel J. Siegel, LLC, knows the law and treats every client personally; there is no bureaucracy, and no TV ads or billboards to pay for, just old-fashioned one-on-one lawyering.
 

Transcript

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Hello and welcome to the latest edition of the Legal Tech podcast. I'm attorney Dan Siegel, and today's podcast is entitled The Myth of the 90-Day Rule. Do I have to treat with the company doctor for 90 days? The podcast is sponsored by the Law Offices of Daniel J. Siegel, LLC and Integrated Technology Services LLC, both based in Pennsylvania. And this podcast addresses an issue that is the most common question that we are asked as attorneys representing injured workers in Pennsylvania worker's compensation claims. It's also the most viewed page on our law firm website related to worker's compensation claims. Why, you may ask, is this such a big issue? The answer is simple. Insurance companies often don't tell injured workers that they don't have to treat with the company Doctor. In addition, insurance companies often don't tell injured workers the truth or don't tell them what their rights really are. Instead, they simply send them to the comp clinic where the doctors know the rules and know how to treat for certain periods of time and then send the workers back to work regardless whether they can do the work or not. So in Pennsylvania, the answer to the question of do I have to treat with the company doctor for 90 days is, in most cases, no. In most cases, you almost never have to treat with the company doctor. The 90-day rule is a myth that has been perpetuated by workers' compensation, insurance companies and employers. And sometimes even the lawyers representing injured workers don't know what the rule is and what it isn't. Just take a look at some law firm websites that tell you you have to treat with the company doctor for 90 days in some limited circumstances. That is true, but in most cases, it is false. So now let me explain to you what the 90-day rule is and more importantly, what it isn't and why it's important that you understand the rule. Understand what your rights are under the workers' compensation system. And think about whether if your attorney doesn't know the 90-day rule, what else maybe does the attorney not really know? Pennsylvania Worker's Compensation law, in particular, Section 306 F-1 one AI of the Workers' Compensation Act says that an employee must treat for a period of 90 days with a healthcare provider designated by an employer, but only if the employer establishes a list of at least six designated health care providers and no more than four of whom may be a coordinated care organization and no fewer than three of whom shall be physicians, then the employer may be required to treat with one of those six doctors, but they can't include on the list a medical provider that is employed, owned or controlled by the employer or the employer's insurer. Unless the employment ownership or control is disclosed on the list. In addition, the law says that it is the duty of the employer to provide a clearly written notification of the employee's rights and duties under the law to the employee. The employer has a further obligation to ensure that the employee has been informed and that he or she understands their rights and duties. The understanding of their rights and duties is required to be based upon an employee's written acknowledgment of having been informed and having understood his or her rights and duties. Any failure of the employer to provide and present evidence of this notification relieves means they don't have to do it. The employee from any obligation for that treatment. And after 90 days, even if the employer has followed the law and followed the 90-day rule and given the notices, is had the acknowledgment signed only then after 90 days can must the and may the employee treat with someone else. Most employers do not comply with this section of the act. And in fact, most injured workers do not have to treat with the so-called company doctor following a work injury. But despite this, I cannot tell you how often because it happens so frequently, our clients are injured. Worker clients tell us that their employers and the insurance adjusters routinely tell them that they have to go to a specific doctor or clinic where the insurance company will not pay for their medical care. In addition, besides that statement not being true, there are doctors who will refuse to treat injured workers in that first 90 days because they have also heard or been told they won't be paid for the care, even though it is not true. The regulations about the tree ring with the nine under the 90 day rule are mostly ignored. As an employer, my worker's comp insurance company has sent me forms to fill out to create my own six-doctor list. Those forms are complicated. There is pain in the neck and we're a small business. It would take us more time to do that than it would be worth. And as a practical matter, obviously, I don't want to tie anyone who works for me into an archaic system like the 90-day rule. Employers have the right to make certain that the injured workers get care with doctors that the employers know and trust. But the reality is the best thing employers can do is do what I tell my clients all the time. When you are hard at work, you are entitled to wage loss benefits if your injury prevents you from working and you're entitled to medical care for the injuries that were related to your work injuries as a result of that. You are free to treat with any doctor or medical provider you want. It doesn't matter whether they're the best or they're not so good. I explain all the time because you can go anywhere. Go to the best the best way to get back to work, the best way to get healthy, and the best way for your employer to likely say, oh, he or she is doing the right thing is for the injured worker to get really good medical care, not care from the company doctor. In short, the 90-day rule is a myth that employers and insurance companies in Pennsylvania have been purposely perpetuating for decades. It's not true. In most cases, injured workers do not have to treat with the company Doctor. We are happy at the law offices of Daniel J. Siegel, LLC, to answer your questions. And we regularly represent injured workers in their worker's compensation claims. We also serve as appeals counsel for numerous lawyers throughout the state and have written a friend of the court briefs for the Pennsylvania Association for Justice on these issues. Our record stands by itself and we encourage you to examine our background and recognize that we are a client-friendly and client-focused law firm where clients come first not billboards, not TV ads, not all of the things that divert the lawyers from their first obligation to the clients. This has been the legal tech podcast sponsored by the Law Offices of Daniel J. Siegel, LLC. You can find us on the Web at Daniel J. Siegel dot com D-A-N-I-E-L-J-S-I-E G-E-L dot com. This podcast is also sponsored by our other firm, Integrated Technology Services LLC, which provides lawyers and small businesses with consulting and training services and workflow management. You can find Integrated Technology Services LLC at TechLawyergy.com, T-E-C-H- L-A-W-Y-E-R-G-Y dot com. I'm Attorney Dan Siegel. I've been representing injured workers for roughly 40 years, and we don't fall for the myth of the 90-day rule, and neither do our clients. Thank you. Thank you for listening to today's Edition of the Legal Tech podcast.