Understanding Workers’ Compensation Time Limits

Navigating the complexities of workers’ compensation can be challenging, especially when dealing with various time limits that must be adhered to for a successful claim. At Franco Muñoz Law Firm, we specialize in representing injured workers and ensuring their rights are protected. In this blog post, we will simplify some of the critical time limits you need to be aware of in the workers’ compensation process in California.

Medical-Legal Process for Represented Employees

If you are represented by an attorney, there are specific deadlines regarding Qualified Medical Evaluators (QME) and Agreed Medical Evaluators (AME):

• QME Requests: Can be made no earlier than the first working day after ten days following a request for a medical evaluation or an objection to a medical decision.
• QME Appointment Scheduling: Employees have ten days from the QME selection to schedule an appointment. Employers may schedule it after this period.
• Examination Scheduling: The QME must schedule an examination within 90 days of the initial request for an appointment.

Medical-Legal Process for Unrepresented Employees

For those without legal representation:

• Initial QME Request: The employee has the first opportunity to request a QME. If they fail to do so within ten days, the employer can submit the form.
• QME Selection and Appointment: Once a panel is assigned, the employee must select a QME and schedule an appointment within ten days.
• Report Corrections: Either party can request factual corrections to a report within 30 days of its receipt.

Communication with Evaluators

Any information provided to a QME must be shared with the opposing party 20 days before the evaluator receives it. If there are objections, they must be raised within ten days.

Time Limits for Reporting

• Initial Evaluation: Must be completed within 30 days after the evaluator sees the employee.
• Supplemental Reports: Should be completed within 60 days of the request.

Treatment Authorization

• Immediate Treatment Authorization: Employers must authorize medical treatment up to $10,000 within one working day after the employee files a claim form.
• Medical Provider Network (MPN) Notifications: Must be provided at the time of injury.

Utilization Review (UR) and Independent Medical Review (IMR)

• UR Time Frames: Decisions for prospective and concurrent reviews must be made within five working days, extendable to 14 days if more information is needed. Retrospective reviews must be completed within 30 days.
• IMR Requests: Must be made within 30 days of the UR decision. Emergency IMR must be completed within three days.

Payment of Bills and Indemnity Benefits

• Medical Bills: Must be paid within 45 calendar days of receipt, or 15 working days if submitted electronically.
• Temporary Disability (TD) Benefits: Should be paid no later than 14 days after knowledge of the injury and disability.

Statutes of Limitations

• Claims: Must be filed within one year of the date of injury or last payment of disability benefits.
• Reopening Claims: Within five years of the date of injury.
• Death Benefits: Within one year of death, but no more than 240 weeks from the date of injury.

Understanding these time limits is crucial for ensuring that your workers’ compensation claim is handled properly and efficiently. At Franco Muñoz Law Firm, we are here to guide you through each step of the process and make sure you receive the benefits you deserve.

If you or someone you know has been injured at work, contact us today to schedule a free consultation. Let us help you navigate the complexities of workers’ compensation and secure the compensation you’re entitled to.