Understanding the Pennsylvania Workers’ Compensation 90-Day Rule in Plain Language

Workers’ compensation in Pennsylvania promises medical care and wage loss benefits after a work injury, but the system runs on deadlines. The 90-day rule is one of the easiest to trip over, and it can affect whether your medical bills get paid. People in Reading, PA hear about it after a supervisor hands over a stack of forms or a nurse case manager calls asking for records. Stress rises, and small choices start to matter. This guide breaks the 90-day rule into clear, practical terms so injured workers and their families know what to do, and when to do it.

What the 90-day rule actually means

Pennsylvania’s 90-day rule ties to medical treatment during the first three months after a work injury. If your employer properly posted a list of approved medical providers, called a panel list, you must treat with one of those providers for the first 90 days. If your employer did not follow the posting requirements, you may choose your own doctor from day one.

This rule is about who pays. Treating with a listed provider during the first 90 days helps secure payment of your bills through workers’ comp. If you go outside the list during that period and the employer followed the posting rules, the insurer can refuse payment for that treatment. After 90 days, you can pick any licensed provider, and the insurer must pay if the treatment is reasonable, necessary, and related to the work injury.

The posting rules employers must follow

The rule only applies if the employer did things the right way. In Reading, PA and across Berks County, many employers comply, but not all do. The employer must:

• Post a list of at least six health care providers in a place where employees can see it, such as a breakroom or near time clocks. At least three must be physicians, and no more than four can be coordinated care organizations.
• Give you written notice of your rights and duties at hire and again after the injury, and get your signed acknowledgment.

If any of this is missing or incomplete, the 90-day treatment requirement may not apply, and you may treat with your own doctor. A workers compensation lawyer can review your paperwork and confirm whether the list was valid.

Day 1 to Day 90: what smart care looks like

Right after a work injury, get medical care promptly. If your employer has a valid panel list, pick a provider from it and schedule an appointment. Many clinics in the Reading area can see injured workers the same day. Bring a simple list of symptoms and where on the job the injury happened. Consistent, accurate history helps connect the injury to your work, which matters for approval of care and wage loss checks.

So what if the panel doctor rushes the visit or downplays pain? It happens. You can switch to another provider on the same list during the 90 days. And you can seek a second opinion from a provider of your choice at any time, though the insurer may only be required to pay for it under certain conditions. Document why you changed, keep copies of referrals, and fill prescriptions at pharmacies that work with the comp insurer when possible.

After 90 days: your doctor, your choice

On day 91, you may treat with any licensed doctor, physical therapist, or specialist you trust, as long as the treatment relates to the work injury. Give the new provider the workers’ comp claim number and the insurer’s contact details. Ask the office to bill the insurer directly. If the insurer delays or denies bills, your own health insurance might pay pending resolution, but that can lead to liens. Clear communication prevents headaches.

Real stories from Reading workers

A warehouse picker in northeast Reading felt a sharp pull in her lower back after lifting an oversized box. HR handed her a panel list with eight providers and had her sign a notice sheet. She used a listed clinic for six weeks, then transitioned to her family doctor at day 92. Her bills were covered because she followed the 90-day rule.

A maintenance tech in Wyomissing was told to “see the company doc” but never saw a posted list anywhere. He visited his longtime orthopedic specialist the next day. The insurer tried to deny payment for the first visits, but there was no proper posting or signed notice. Payment followed after a formal challenge.

These small facts make big differences.

Why the 90-day rule trips people up

Pain pushes people to act fast. A spouse drives to the nearest urgent care. A supervisor suggests their preferred clinic without mentioning a list. Or an injured worker forgets to sign the notice form. Later, the insurer disputes bills or delays approval for an MRI. That is where timing and documentation matter.

If there is a panel list, use it for those first 90 days, and keep copies of every form. If there is no valid list, choose the provider who knows your medical history. In either case, report the injury to your employer right away. Pennsylvania allows up to 120 days to give notice, but waiting risks problems, especially with witnesses and video footage.

How this rule affects wage loss checks

Medical care and wage loss are connected. Panel doctors control work status notes, including light duty and return-to-work dates. If a panel doctor writes that you can return with restrictions, and your employer offers a real light-duty position that matches those limits, your wage loss checks may stop or reduce. This is why workers often request a second opinion, especially when pain persists.

A workers compensation lawyer can compare restrictions to actual job tasks. In Reading, light workers compensation lawyer duty differs between a Fairgrounds-area retailer and a Tuckerton warehouse. If the offered job conflicts with the restrictions, that can be challenged.

Independent medical exams and the 90-day window

Insurers often schedule an independent medical exam, called an IME, after several weeks of treatment. The IME doctor does not treat you. They write a report that can affect approvals, including therapy or surgery. The 90-day rule does not control IMEs, but your initial choice of provider can shape the medical record leading up to an IME. Keep symptom diaries, bring a list of medications, and be accurate during the exam. Overstating or understating pain can hurt your claim.

Common myths that cause trouble

• “I can pick any doctor right away.” True only if the employer did not properly post and document the panel list.
• “If I go off the list, I lose my case.” Treatment might not be paid for within the 90 days, but your entire claim does not vanish. Facts matter.
• “After 90 days, the insurer must approve any treatment.” Approval still depends on reasonableness, necessity, and relation to the work injury.

Simple checklist for Reading, PA workers

• Report the injury to a supervisor as soon as possible, in writing if you can.
• Ask for the posted panel list and a copy of your rights and duties form.
• If the list is valid, choose a provider from it for the first 90 days, and keep all paperwork.
• Track symptoms, missed work, and mileage to medical visits.
• Talk with a workers compensation lawyer in Reading, PA if you doubt the list’s validity, face a denial, or struggle with return-to-work demands.

How a Reading workers compensation lawyer helps

Local experience matters with employers and providers in Berks County. A lawyer can confirm whether the panel list is valid, coordinate a switch to another listed provider when care stalls, and prepare for an IME with focused questions. If wage loss checks stop after a light-duty offer that does not line up with your restrictions, a lawyer can challenge the suspension. And if the insurer denies surgery or therapy, a lawyer can request a utilization review or file a claim petition, then build the medical record step by step.

People call after they miss a deadline, but help early in the case prevents most pitfalls. If you live near Centre Park, work along the 222 corridor, or commute from Shillington or Muhlenberg, local access to the right clinics and a clear plan can steady the process.

Timing, forms, and the practical next step

Pennsylvania allows three years from the date of injury to file a claim petition, but waiting that long can cost credibility and income. The first 90 days set the tone. Use the right providers if the list is valid, or your own doctor if it is not. Keep records, and ask questions. If anything feels off, a short call with a workers compensation lawyer can clarify your options in minutes.

If a work injury happened in Reading, PA, and you have questions about the 90-day rule, give the office a call or request a consultation online. Bring the panel list, your signed acknowledgment, and recent medical notes. Clear answers now can prevent bigger fights later.

This article provides general information and is not a substitute for legal advice; consult with experienced lawyers for personalized guidance Attorney Advertising: The information contained on this page does not create an attorney-client relationship nor should any information be considered legal advice as it is intended to provide general information only. Prior case results do not guarantee a similar outcome.