Workers’ Comp “90 Day rule”

Workers' Comp "90 Day Rule"

Most of the disabling work-related claims we see are strain injuries to backs, knees, and shoulders.

A strain injury should resolve in 90 days. If the injured worker is not back to work and on the road to recovery by the 90th day, it may be an indicator that further questions should be asked to determine what is driving the claim.

It could be as simple as the injured employee may need further diagnostic workup, such as an MRI to determine whether there is a tear or a more complex injury. But it also may be an indication the worker is either consciously or unconsciously embracing the injury and their disabled status.

At that 90 day point, it’s crucial that you, as the employer, don’t throw your hands up and leave the claim solely in the hands of the insurance carrier. Instead, you need to dig into the details and do what you can to remove roadblocks and get the injured worker and the claim on the road to resolution.

Questions to ask the claims adjuster:
Have they established a target date for recovery with the physician?
Has all diagnostic work up been completed?
Has a nurse case manager been assigned? Would a field nurse meeting with the physician add value?
Is it time to consider an independent medical exam?
Are there indications the worker is misrepresenting their symptoms? If so, would a social media check and/or surveillance be appropriate?
Is there a language barrier? If so, is an interpreter being utilized consistently?

Trust your instincts on a work comp claim where you sense lack of recovery may become an issue. Propel has a team of workers’ comp consultants who can discuss your concerns with you and your insurance carrier to develop a comprehensive plan of action. We want to ensure these cases are identified and addressed.

Jennifer Macdonald

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