Morgan’s Tip of the Week- 120-day rule and subsequent conditions


After we accept a claim as compensable, sometimes new conditions arise that may or may not be compensable.  A great example of this is a referral to a psychiatrist from the authorized doctor. 

In this instance, where a new condition arises more than 120 days after the accident, are we stuck with it because the claim is compensable under the 120-day rule?

The answer is no, and you actually can assert another 120-day pay and investigate period on the new condition.  As the Churchill case (below) spelled out, we do however have a duty to send the 120-day letter so the claimant is aware we are invoking the right to pay and investigate.  The letter does not need to be sent with the first provision of treatment for that new condition, but it needs to be sent “as soon thereafter as reasonably practicable.”   The clock would start with the first treatment for that new condition.  To be safe, you could even send the 120-day letter to the claimant with the appointment letter.  The letter doesn’t start the clock, it would still be that first appointment. 

Under the logic in the Churchill case, without a 120-day letter, we may get stuck with the condition after more than 14-ish days or so.  I say “ish” because we do not have a concrete timeframe from the 1st DCA other than that 59 days after that first treatment is too long.

As always, please let me know if you have any questions.

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And my earlier Tips of the Week are here:


Morgan Indek | Managing Partner