Don’t Miss Your Workers’ Compensation Deadlines
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There are many different deadlines in the Pennsylvania workers’ compensation system. Missing some has minor consequences, while missing others can end a claim entirely. Some deadlines apply to the injured worker, some to the employer or insurance company, and some to medical providers. Any of these deadlines, missed by anyone, could affect your rights.
Just as important as the length of each deadline is what starts the clock. Here are the deadlines that come up most often, with the event that triggers each one.
Pennsylvania workers’ compensation deadlines at a glance
| Deadline | Time limit | What starts the clock |
|---|---|---|
| Tell your employer about the injury | 21 days to protect benefits from the start; 120 days outer limit | The injury, or when you knew or should have known of the injury and its possible connection to work |
| Insurer accepts, denies or pays temporarily | 21 days | The employer’s notice or knowledge of your disability |
| Temporary compensation period | Up to 90 days | The period in which temporary compensation is paid or payable under a Notice of Temporary Compensation Payable |
| Treat with a valid employer provider list | 90 days | Your first visit to a listed provider |
| Tell your employer about a new, non-listed provider after the 90 days | 5 days | Your first visit to that provider |
| File a Claim Petition | Generally 3 years | The date of injury, or the last payment of wage-loss compensation |
| Challenge a Notification of Suspension or Modification | 20 days | When you receive the notification |
| Appeal a judge’s decision to the Workers’ Compensation Appeal Board | 20 days | Notice of the judge’s decision |
| Appeal the Appeal Board’s decision to Commonwealth Court | 30 days | The Appeal Board’s order |
| Ask the Pennsylvania Supreme Court to hear an appeal | 30 days | The Commonwealth Court’s order |
| Notify the Uninsured Employers Guaranty Fund | 45 days | When you knew your employer had no workers’ comp insurance |
| File a Claim Petition against the Uninsured Employers Guaranty Fund | No sooner than 21 days, and no later than 180 days | Your notice to the Fund |
Every one of these rules has details and exceptions that a table can’t capture, so get advice before you assume a deadline has passed.
Notice of injury: 21 days and 120 days
The injured worker must notify the employer of the injury. Notice must be given to someone in a supervisory or management role, not just a co-worker. It does not have to be in writing, although a written report you keep a copy of is easier to prove.
- Within 21 days: benefits can be paid from the beginning of your disability.
- Between 21 and 120 days: no benefits are due before the date notice was given, but benefits may be awarded from that date forward.
- After 120 days: the claim may be barred entirely.
The clock does not always start on the day of the accident. If your employer already knew about the injury, that knowledge can count as notice. And when the nature of the injury or its connection to work was not known to you, the time for notice begins when you knew, or reasonably should have known, that you were injured and that the injury was possibly related to your job. This comes up often with occupational diseases and injuries that develop gradually.
Even when an injury is reported on time, the longer you wait, the more likely the employer or insurance company will doubt that anything really happened at work. If your case goes before a Workers’ Compensation Judge, that judge may have the same doubts.
Filing a Claim Petition: generally three years
Reporting the injury to your employer is not the same as filing a claim. If the insurer denies the claim or never pays, the legal claim is a Claim Petition, which generally must be filed within three years of the date of injury. If the insurer paid wage-loss compensation, the three years generally run from the most recent payment.
For injuries caused by repetitive activity, the date of injury is often treated as the last day the worker performed that activity, but these cases are fact-specific. Occupational disease claims have their own timing rules, including a requirement that disability generally occur within 300 weeks of the last exposure. As above, the longer you wait to file, the more likely the employer, insurance company or even the judge may doubt your story.
Company doctor: 90 days from your first visit
If your employer has a valid list of at least six designated health care providers, and properly notified you of your rights and duties, you must treat with a provider on that list for 90 days from your first visit to a listed provider. The clock does not start on the date of injury. There are several exceptions:
- Emergency care can come from any provider.
- A listed provider can refer you to another provider, and that care is covered.
- If a listed provider recommends invasive surgery, you can get a second opinion from a doctor of your choice, paid for by the employer.
- If the list or the notice doesn’t meet the legal requirements, you can treat with a provider of your choice from the start.
After the 90 days, you may switch to a provider of your choice, but you must notify your employer within 5 days of the first visit, or the employer may not have to pay for treatment before it receives notice. Contact a Workers’ Compensation Specialist Lawyer to learn all the details.
Duration of benefits
If an injured worker is legally defined (not by medical definition, or even common sense, but by the legal definition) as totally disabled, wage-loss benefits have no fixed end date. If the worker is legally defined as partially disabled, wage-loss benefits can last a maximum of 500 weeks, and medical benefits for the work injury may continue beyond that. After 104 weeks of total disability benefits, the insurer can request an Impairment Rating Evaluation; a whole-body rating below 35% can change the worker’s status to partial disability and start the 500-week limit, without reducing the weekly check. The insurance company has many tactics to classify an injured worker as only partially disabled, so any IRE request deserves a close look.
Accepting or denying the claim: 21 days
The insurance company generally has 21 days after the employer has notice or knowledge of the worker’s disability to accept the claim, deny it or begin temporary payments, by filing specific forms with the Bureau of Workers’ Compensation and sending a copy to the injured worker. Failing to respond on time can expose the insurer to penalties and, in some cases, an order to pay your lawyer’s fee.
Temporary compensation: a 90-day investigation period
The insurance company can pay a claim on a temporary basis under a Notice of Temporary Compensation Payable while it completes its investigation. This does not add 90 days to the 21-day deadline, and the 90 days are not counted from the date of the accident. They are the period during which temporary compensation is paid or payable.
If the insurer decides to stop paying, it must send a Notice Stopping Temporary Compensation within 5 days after the last payment, along with a denial, all within that 90-day period. If it fails to do so properly and on time, the claim is generally treated as accepted, and the insurer may face penalties or lawyer fees.
Appeals: 20 days, then 30 days
When a case is fully fought before a Workers’ Compensation Judge (WCJ) to a final decision, one (or sometimes both) parties may file an appeal. The deadline to appeal the WCJ’s decision to the Workers’ Compensation Appeal Board (WCAB) is 20 days. Appeals can take many months to be decided. A further appeal to the Commonwealth Court may be filed within 30 days of the WCAB’s decision. A final level of appeal may be taken only with the permission of the Supreme Court of Pennsylvania, which picks and chooses the cases it will accept. A Petition for Allowance of Appeal must be filed within 30 days of the Commonwealth Court’s decision. Between levels of appeal, either party may also ask for rehearing or reargument on limited grounds.
A supersedeas decision, which only decides whether payments continue while a case is pending, is different from a final decision and generally cannot be appealed right away.
Other deadlines worth knowing
- Uninsured employer: if your employer had no workers’ comp insurance, notify the Uninsured Employers Guaranty Fund within 45 days after you knew the employer was uninsured. A Claim Petition against the Fund cannot be filed until at least 21 days after that notice, and it must be filed within 180 days after the notice. These are the basic timing rules; other requirements apply to Fund claims as well.
- Final Receipt: if you signed a Final Receipt but your disability had not actually ended, a petition to set it aside generally must be filed within three years of your last payment.
- Medical bills: once the provider submits the required bill and medical records, the insurer generally has 30 days to process it. Disputes over whether treatment is reasonable or necessary are handled through Utilization Review; disputes over whether treatment is related to the work injury are separate.
Deadlines are where good claims most often get lost. If you are unsure whether a clock is running, call 610-892-9300 or text 610-255-7183, and a Certified Workers’ Compensation Specialist will review your dates for free.