Time Limitations on Workers' Compensation

By Kenton Koszdin Law Office on March 6, 2023 | In Workers Compensation

Time Limitations on Workers’ Compensation

Workers’ compensation protects workers after on-the-job injuries. But to receive benefits, you must act within the workers’ compensation time limits.

The time limit to report workers’ comp injury is complicated. The start of this period depends on the nature of your injury or illness and how it affected you. All deadlines get calculated from this date. These deadlines also answer the question, “How long do I have to sue for work-related injuries?”.

Fortunately, help is available. A workers’ compensation attorney in Los Angeles can analyze your situation and determine the deadlines for each stage of the process.

Reporting the Injury to Your Employer

The first deadline in a workers’ compensation case is your time limit to report workers’ comp injury. You have 30 days to inform your employer of injuries that arise from a specific event. Specific events include:

  • Accidents at your workplace;
  • Accidents at job sites if you had a job-related reason for going there;
  • Motor vehicle accidents if driving is part of your job.

While written notice is preferable, it is not necessary. If your employer was present during your accident or found out about it later, you may have already met this deadline.

Time to File a Workers’ Comp Claim

Your employer will provide a claim form. You must file workers’ compensation claims within one year from the date of injury or illness by returning this form to your employer.

The claim form requests:

  • Your name
  • Your Social Security number
  • Your home address
  • Your email address
  • The date and hour of the injury
  • The location where the injury happened
  • A description of your injury
  • Your signature

The employer fills out the employer section of the form and files the document with its workers’ compensation insurance carrier.

Time Limit Exceptions

The workers’ compensation deadlines to file a claim include two other measures. You can file a claim within one year from the date that:

  • Your temporary disability benefits stop;
  • Your emergency medical treatment benefits stop.

Your employer’s worker’s comp insurer must cover emergency medical treatment. It must also pay temporary disability starting 14 days after your doctor determines you cannot work. You can file a claim within one year after the date these benefits stop.

These situations might happen when you need immediate and prolonged treatment after your accident. Suppose that you suffered a coma, severe injuries, serious burns, or another condition that prevented you from filing. The other workers’ compensation deadlines will give you additional time.

Federal Time Limits to File a Workers’ Comp Claim

Federal employees should file workers’ compensation claims within three years from the injury date. They can extend their workers’ compensation deadlines to file if they give their employers notice within 30 days of the injury.

Occupational Disease or Cumulative Trauma

statute of limitations for workers comp claims

You can seek workers’ compensation benefits for occupational diseases and cumulative trauma. This type of injury or illness can result from:

  • Toxins in your workplace
  • Repetitive stress
  • Radiation
  • Loud noises

When you seek workers’ compensation benefits for occupational diseases, repetitive stress injuries, or other work-related injuries from cumulative trauma, you must file your claim within one year from the date that:

  • You missed work due to your occupational injury or illness;
  • You knew or should have known that your occupational injury or illness was work-related.

There is a risk of a workers’ compensation claim denial. A workers’ compensation insurance carrier can argue that the time limit started when you should have known that your injury or illness was work-related, even if you had no such actual knowledge.

Workers’ Comp for Minor Injuries

Workers’ compensation does not cover minor industrial injuries that only require first aid. Examples of minor injuries include:

  • Scratches
  • Cuts
  • Burns
  • Splinters

If an injury or illness requires any medical treatment beyond the one-time application of first aid, it is not considered a minor injury, and you can seek workers’ compensation benefits.

A workers’ comp insurer can dispute the severity of your injury. You might need to submit to an AME or QME workers’ comp examination.

Time Limits for Medical Legal Process

A medical-legal report is a report written by a doctor for a legal proceeding. The time limits for the medical-legal process include the amount of time to:

  • Request an evaluation
  • Pick a medical evaluator
  • Undergo an examination
  • Submit a report

Two types of evaluators can submit a medical-legal report. A qualified medical evaluator (QME) is selected from a list of three doctors randomly chosen by the state workers’ comp agency. An agreed medical evaluation (AME) happens when both sides agree on a doctor.

The exact workers’ comp time frame for a medical examination depends on whether the employee has a workers’ comp attorney.

Represented Employee

The worker or claim administrator can request a QME to resolve a medical dispute. When an employee has a workers’ comp attorney, these conditions for the medical-legal process apply:

  • The parties cannot request a QME until 10 days after a request for examination or objection gets filed;
  • The parties have 10 days to strike any name from a QME list;
  • The employee has 10 days after selecting a QME to schedule an appointment;
  • If the employee does not select a QME after 10 days, the employer can pick one;
  • The QME has 60 days after the initial request to see the employee.

The parties can agree to conduct an AME at any time during the medical-legal process.

Unrepresented Employee

When an employee has no workers’ comp attorney, the employee takes the lead in requesting and picking the QME. The conditions include:

  • The employee can request a QME at any time;
  • The employer can send a QME request to the employee but must wait at least 10 days to file it with the state workers’ comp agency;
  • The employee can pick a QME of their choice if the state does not provide a panel;
  • The employee has 10 days to select a QME and make an appointment after receiving the panel;
  • The employer can pick a QME if the employee does not pick one within 10 days.

Again, the parties can agree on an AME at any point

Communications with QME

The parties can submit information, such as medical records or test results, to the QME. These conditions apply :

  • Parties cannot submit information until 20 days after serving a copy on the other party;
  • Parties cannot submit nonmedical information if the other party objects within 10 days of receiving it.

If the parties agree to an AME, the parties must agree on the information submitted.

Time Limits for Reporting

The QME must prepare the report within 30 days after the evaluation. They must submit a supplemental report within 60 days after the date of a request.

Time Limits for Medical Treatment

time limit to report workers comp injury

Your workers’ comp benefits include emergency medical treatment. When you suffer a serious injury or illness that requires immediate medical attention, the workers’ compensation plan will cover an emergency room visit. Notify the hospital that you suffered a workplace injury so it can get paid.

When you have a non-emergency work-related injury, the workers’ compensation claim administrator must authorize up to $10,000 for treatment within one day after a claim. You use these funds while the workers’ comp claim administrator determines whether you will receive workers’ compensation benefits. These benefits cover you if you need immediate and prolonged treatment for serious burns, coma, severe injuries, or other debilitating conditions.

Your employer and its workers’ comp insurer can choose to provide treatment through a medical provider network (MPN). You must use an in-network provider for it to be covered by your workers’ comp claim.

If you have health insurance, you can predesignate your doctor. When you suffer a workplace injury, you can use your predesignated doctor instead of the MPN.

Workers’ compensation deadlines for medical treatment depend on whether you are covered by your employer’s MPN. If your employer has no MPN or you predesignated a physician, your employer has 30 days of medical control.

If your employer has an MPN and you did not predesignate a doctor:

  • Your employer has control over your treatment indefinitely;
  • You can switch MPN doctors after the initial evaluation;
  • You have 60 days to schedule a second opinion if you disagree with the evaluation;
  • The second doctor must report in 20 days;
  • You can request a third opinion;
  • If you still disagree, you can request an independent medical reviewer (IMR);
  • The IMR is selected within 10 days of your request;
  • You have 60 days to schedule the IMR appointment;
  • The IMR must report within three days for a serious health issue or 20 days for other traumatic injuries and occupational diseases.

Your workers’ comp claim covers all treatment.

Time Limits for Utilization Review

Workers’ comp insurers do not want to pay for unnecessary or unreasonably costly medical benefits. They employ utilization reviews to determine the appropriateness and cost of the treatment you receive for your occupational illness or work-related injury.

Generally speaking, if your doctor recommends treatment according to the medical treatment utilization schedule (MTUS), the insurer’s claim administrator should approve your treatment.

In fact, the claim administrator cannot deny or change any treatment recommended by your doctor. Instead, the workers’ comp claim administrator must have a physician reviewer look at the proposed treatment and either deny it or recommend an alternative. However, workers’ compensation claim administrators can delay approval while awaiting further information from your doctor.

These time limits apply to utilization reviews and treatment approvals:

  • During the first 30 days of treatment, the claim administrator can review treatment you have already received for your work-related injury or illness but not prospective treatment;
  • During the first 30 days, the claim administrator can review prescriptions, non-emergency surgeries, mental health treatment, in-home healthcare, some medical imaging and testing, and durable medical equipment (such as hospital beds or wheelchairs) costing up to $250;
  • When a prospective utilization review is permitted, the workers’ comp claims administrator must send your request for authorization (RFA) to the utilization reviewer (UR);
  • The UR must either defer the review or perform the review within five days;
  • The UR can extend the deadline by 14 days;
  • After completing the review, the UR must report the decision to your doctor within 24 hours;
  • To perform a retrospective utilization review, the workers’ comp claim administrator must complete the review within 30 days of receiving information about the treatment.

A utilization decision controls treatment for 12 months.

If a Utilization Review Is Deferred

The workers’ comp claims administrator can defer utilization review. The insurer might do this to avoid spending money on a utilization review until the workers’ comp claim gets approved.

To defer a utilization review:

  • The insurer has five days after you send your RFA to send a deferral of the utilization review;
  • After establishing liability for the claim, the workers’ comp insurer must perform a retrospective utilization review within 30 days;
  • When you seek additional treatment, the insurer must perform a prospective utilization review;
  • The UR must perform these reviews within five days of receiving your RFA form.

The utilization review will determine whether the workers’ comp insurer will pay for past and future treatment.

Independent Medical Review

An independent medical review (IMR) happens when you disagree with treatment. In other words, an IMR is requested from your side rather than the workers’ comp insurer’s side. When you disagree with the outcome of a utilization review, you must follow these time limits:

  • You have 10 days to request an IMR of prescription drug treatments;
  • You have 30 days to request an IMR for all other medical treatment;
  • Your employer has to provide documents to the IMR doctor within 10 days of any records request;
  • The IMR doctor has 24 hours to acknowledge receipt of the case and 30 days to complete the IMR for regular conditions;
  • For emergency conditions, the IMR doctor must complete the review within three days;
  • The workers’ compensation claim administrator must authorize services within five days and pay the provider within 20 days after IMR approval.

Your IMR can help you get medical treatment that your MPN doctor refuses to provide based on their diagnosis. The IMR doctor is called “independent” because the doctor should apply medical principles objectively.

Time Limits for Bills

workers comp deadlines

If you do not see an MPN doctor for treatment, you need to submit bills to the workers’ comp insurer. Time limits cover:

  • Submitting bills
  • Approving or denying bills
  • Paying bills

These time limits apply to treatment and medical-legal bills.

Bill Submission

You submit bills using a request for payment (RFP) within 12 months of receiving treatment. Late bills get denied automatically.

Bill Payment

The workers’ compensation insurer must handle treatment bills within certain time limits:

  • Pay paper bills within 45 days;
  • Pay electronic bills within 15 days;
  • Object to bills within 30 days with an explanation of review (EOR).

The insurer must pay QME or AME bills within 60 days or object to them with an EOR.

Second Review

If you disagree with an EOR, you can request a second bill review within the following time frames:

  • 90 days for you to request a second bill review;
  • 14 days for the insurer to respond;
  • 21 days for the insurer to make additional payments on the bill.

The same process applies to treatment and medical-legal bills.

Independent Bill Review

Either party can request an independent bill review (IBR) within 30 days after a second review. Time frames include:

  • 30 days to assign an IBR reviewer;
  • 60 days for a reviewer’s decision;
  • 30 days to respond to document requests;
  • 20 days to appeal.

If the reviewer orders additional payments, payments are due within 45 days for paper bills, 15 days for electronic bills, and 20 days for medical-legal bills.

Voucher Time Limits

If your work-related accident caused permanent injury or illness, you might be eligible for supplemental job displacement benefits. This benefit gets paid as a voucher that you can use for job retraining or skill enhancement.

Conditions that apply to vouchers include:

  • Your employer has 60 days to offer regular, modified, or alternative work after your physician approves your return to work;
  • Your doctor must issue a voucher report with the return to work approval;
  • The voucher must be issued within 20 days if your employer does not offer you work and you cannot return to work for your employer;
  • You must use the voucher within two years of receiving it or five years from the date of injury.

The voucher is non-transferable. You must use it to improve your education or skills at an accredited or state-approved school.

Time Limits for Indemnity Benefits Payment

Indemnity benefits replace your wages from missed work. California has a mandatory three-day waiting period before you become eligible for these temporary disability payments.

After missing more than three days or parts of days that add up to three days, you become eligible for indemnity benefits. Your payments will include benefits for the three days you missed work before becoming eligible.

The following guidelines apply to indemnity benefits:

  • You begin receiving temporary disability within 14 days after your employer becomes aware of the injury;
  • You can receive up to 104 weeks of temporary disability benefits in the five-year period after your injury date;
  • For certain types of workplace injuries, you can receive up to 240 weeks of temporary disability benefits in the five-year period starting on your date of injury;
  • You receive payments every two weeks once the payments start;
  • Temporary disability payments can stop when the employer offers to return you to work for at least 85% of your normal wages.

Indemnity payments pay you two-thirds of your pre-accident wages up to a statutory maximum.

Time Limits for Investigation and Litigation

The state’s deadline for employers requires them to provide a claim form within one day after notice of your injury. The workers’ comp time limit includes these guidelines:

  • One year to file the form to meet the statute of limitations for workers’ comp claims;
  • 90 days to issue a claim denial.

When you disagree with a claim decision, you can file an application for adjudication:

  • The employer or insurer must file an answer within 10 days;
  • Medical reports obtained by either party must be provided to the other party within 10 days.

If the insurer misses any of these deadlines, your claim is presumed to be accepted.

Time Limits for Appeals

workers comp time frame

When you receive an adverse decision in the adjudication, you can petition for reconsideration. In this process:

  • You have 20 days after the decision to petition for reconsideration or review;
  • The insurer must answer the petition within 10 days of receipt.

You can seek further review with the California Court of Appeals or the Supreme Court of California after a decision on your petition for reconsideration:

  • You must file a petition for writ of review with the Court of Appeals within 45 days of the outcome of the petition for reconsideration;
  • The insurer must answer the petition for writ of review within 25 days after the petition;
  • You can file a petition for writ of certiorari with the Supreme Court within 10 days after receiving a Court of Appeals decision;
  • The insurer must respond to your petition for a writ of certiorari within 20 days of receipt.

The Supreme Court is the court of last resort in your case.

Other Time Limits

State law has many more workers’ comp deadlines in addition to the one-year statute of limitations for pursuing workers’ comp benefits for a workplace injury or illness. Some deadlines include:

  • Five years after the date of injury to reopen a previous workers’ comp claim;
  • One year to file under California Labor Code 132a if your employer fired or discriminated against you for filing a workers’ comp claim;
  • 12 months for a work-related injury or illness that resulted from serious and willful misconduct regarding your employer’s dangerous workplace conditions under state law;
  • One year after the date of death or 240 weeks from the date of injury that resulted in death to file a workers’ comp claim;
  • 18 months for a medical provider to file a lien, measured from the date they provided medical care for your work-related injury;
  • One year for a petition for contribution when multiple employers or insurers are liable for a workers’ compensation claim for an occupational illness caused by cumulative trauma;
  • Two years to claim punitive damages under California Labor Code 5814 for unreasonably delayed or denied workers’ comp benefits.

The result of an injured employee missing the state’s deadline is a possible claim denial.

Why Do People Miss Their Workers’ Compensation Time Limits?

Most people who miss the state’s deadlines for filing workers’ compensation claims do so inadvertently. Some reasons include:

Not Understanding How Workers’ Compensation Works

Many workers think that workers’ compensation is welfare. Some think filing a workers’ comp claim will be complicated and not worth the effort. Others might not understand they are covered even when they are new to a job or only working as a temporary employee.

Workers’ compensation is insurance. When you get hurt, your workers’ comp benefits get paid by an insurer. State laws require almost all employers to buy workers’ compensation insurance. They also require insurers to pay benefits to all employees injured during the course and scope of their jobs.

When you get injured, the workers’ compensation system makes it easy for you to pursue workers’ comp benefits. But claimants must still meet workers’ comp deadlines to receive benefits, so you should contact a lawyer for a free consultation as soon as possible after the date of injury.

Not Knowing Their Injuries Are Covered

With limited exceptions, all job-related injuries and illnesses are covered by workers’ compensation. Covered injuries include any work injury resulting from an on-the-job accident, including:

  • Incapacitating injuries, like coma
  • Severe injuries, like a broken bone
  • Minor injuries, like a sprained joint or strained muscle

Many employees do not know that workers’ compensation also covers an occupational illness or latent injury resulting from cumulative trauma, such as:

  • Diseases from toxins
  • Repetitive stress injuries
  • Hearing loss from loud noises
  • Radiation poisoning

Complex laws determine whether a medical condition is covered by workers’ compensation. Contact a lawyer for a free consultation to determine whether you can file a claim.

Considering Their Injuries Not Severe Enough

Workers’ compensation benefits get paid regardless of what type of injury was suffered, with very few exceptions. Workers’ comp might not cover minor industrial injuries that only require one-time first aid.

Not Getting Injured During an Accident

You do not need to get injured in a job-related accident. You can give written notice and seek benefits for an occupational disease that resulted from long-term exposure to cumulative trauma. For example, you can file a claim for carpal tunnel syndrome, hearing loss, or stress fractures if they result from your job or workplace conditions.

Thinking They Were Off the Worksite

State laws governing workers’ compensation give a broad definition of “work injury.” Your injury does not need to happen in an office building, warehouse, or factory for you to file a claim for disability and medical benefits.

A work injury for filing a workers’ comp claim can happen:

  • In a motor vehicle accident, if driving is part of your job;
  • At a remote job site, if you were there for work;
  • In someone else’s business or home, if you were performing job duties there.

Workers simply need to link their injury to their job to receive benefits, regardless of where the injury happened.

Meeting Your Workers’ Compensation Deadlines

When you suffer an occupational disease or work injury, you need to focus on your health and medical care. Workers’ compensation deadlines can complicate your efforts to seek medical attention and cause you to inadvertently lose your claim.

A workers’ compensation attorney can help you with these time-sensitive tasks when you file a workers’ comp claim. Contact us to get a free case review and learn how an experienced attorney can help you when filing a workers’ comp claim.

Simple Share Buttons