Batch 1 — first 35 flashcards from Important Timeframes in Workers’ Compensation Cases

Question 2

When must an employer provide a DWC-1 claim form after learning of a work injury?

Answer 2

Within 1 working day of knowledge/notice of injury.

Question 3

When must an injured worker return the completed DWC-1 form?

Answer 3

As soon as possible; to preserve full retroactive benefits, within 30 days of injury.

Question 4

Employer’s duty to start benefits after receiving DWC-1 if injury is undisputed?

Answer 4

Within 14 days of knowledge/receipt.

Question 5

Maximum time an employer/insurer has to accept or deny a claim after knowledge of injury?

Answer 5

90 days (or presumed compensable if no denial).

Question 6

Time limit for employee to report injury orally or in writing to employer to avoid late notice defense?

Answer 6

30 days from injury.

Question 7

Initial investigation period allowed after claim filed?

Answer 7

Up to 90 days to gather evidence before decision.

Question 8

When must emergency medical care be provided?

Answer 8

Immediately, even before claim decision.

Question 9

When must non-emergency initial treatment authorization be given once claim filed?

Answer 9

Within 1 working day after employer learns of injury.

Question 10

How many visits are automatically authorized before claim acceptance/denial?

Answer 10

Up to $10,000 in treatment or 24 visits (whichever comes first).

Question 11

When must employer post notice of WC rights?

Answer 11

At all times, conspicuous at worksite.

Question 12

Time limit for first TD payment if disability accepted?

Answer 12

Within 14 days of employer knowledge.

Question 13

Waiting period before TD starts (unless disability >14 days or hospitalized)?

Answer 13

3 calendar days.

Question 14

Maximum TD duration for most injuries?

Answer 14

104 compensable weeks within 5 years of DOI (some exceptions).

Question 15

Max TD for certain severe conditions (burns, chronic lung, etc.)?

Answer 15

240 weeks within 5 years.

Question 16

How soon must PD advances start after TD ends if worker still impaired?

Answer 16

Within 14 days after last TD.

Question 17

When must insurer send notice of TD start/stop?

Answer 17

Within 14 days of start or stop/change.

Question 18

Statute of limitations to file WC claim (generally)?

Answer 18

1 year from injury or last benefit provided.

Question 19

Time for employer to send “Notice of Potential Eligibility” to injured worker?

Answer 19

Within 14 days after DWC-1 filed.

Question 20

Deadline to request a QME/AME panel after claim dispute arises?

Answer 20

Within 10 days (if party gets first right) or within 30 days total; else opposing party picks.

Question 21

Time to schedule a QME exam after panel assigned?

Answer 21

Within 60 days (extensions for good cause).

Question 22

When must QME report be served after exam?

Answer 22

Within 30 days of exam (extendable to 45 with notice).

Question 23

Time to object to QME report (request new panel or deposition)?

Answer 23

10 days for first pick, generally 30 days to dispute.

Question 24

Employer must authorize up to how much treatment during 90-day investigation?

Answer 24

Up to $10,000.

Question 25

Time to issue **delay notice** if claim not accepted/denied within 14 days?

Answer 25

**Within 14 days** from knowledge; must explain investigation.

Question 26

Max time to decide **UR (Utilization Review)** request for treatment?

Answer 26

**5 business days** (2 days if urgent).

Question 27

Time to respond to **IMR (Independent Medical Review)** decision?

Answer 27

**20 days** to implement/appeal as allowed.

Question 28

Limit for **vocational rehab/SJDB voucher request** after MMI/PD?

Answer 28

Generally **within 1 year** of last TD or PD payment notice.

Question 29

Deadline to **file Application for Adjudication** with WCAB?

Answer 29

Usually **1 year** from injury/benefits.

Question 30

Time insurer must pay undisputed medical bills?

Answer 30

**45 working days** from receipt of complete bill.

Question 31

Penalty if insurer unreasonably delays/denies payment?

Answer 31

Up to **25% of amount delayed** (max $10,000) LC §5814.

Question 32

When must **Supplemental Job Displacement Benefit (SJDB)** voucher be provided?

Answer 32

Within **60 days** after receipt of MMI report showing no return to work.

Question 33

Time to issue **permanent disability rating** after MMI report?

Answer 33

Typically **within 30 days**.

Question 34

Deadline for insurer to **pay PD award after award issued**?

Answer 34

**14 days** after WCAB order.

Question 35

Max time to **appeal WCAB decision**?

Answer 35

**20 days** (add 5 for mailing).

Question 36

Time to request **reconsideration** of WCAB award?

Answer 36

**20 days** (25 if mailed).