You may be wondering, What Is the 90-Day Rule for Workers’ Compensation in California? The 90-day rule in California workers’ compensation law means that if your employer or insurer doesn’t accept or deny your claim within 90 days of submission, the injury is presumed compensable—making you eligible for benefits. If an employer fails to respond to a workers’ compensation claim within 90 days, the law considers the claim accepted by default. Additionally, employers must respond to a workers’ compensation claim within 14 days of receiving notice of the injury.
The workers’ compensation 90-day rule requires employers and their insurers to investigate and respond to injury claims within 90 days. If they fail to accept or deny the claim in that time, the injury is presumed work-related, granting the employee access to benefits. This period starts from the injury date or when the employee becomes aware the condition is job-related, including gradual injuries like repetitive trauma.
With decades of experience advocating for injured workers in California, I’ve helped many clients enforce their rights when employers delay or deny claims unfairly.
In this article, I’ll explain exactly how the 90-day rule works, what happens if your employer misses the deadline, and how you can protect your access to workers’ comp benefits.
Overview of the Workers’ Comp 90-Day Rule
Before diving into the detailed timeline of the 90-day rule, it’s important to understand the key steps involved in reporting a work injury and how the claim process unfolds. The following table summarizes the critical deadlines and actions that injured employees and employers must follow to ensure your workers’ compensation claim proceeds smoothly.
| Step | Timeline |
|---|---|
| Employee reports injury | Within 30 days of the injury |
| Employee files DWC-1 form | Starts the official workers’ comp claim |
| Employer/insurer investigates | Must accept or deny within 90 days |
| No decision by day 91 | Injury is presumed compensable by law |
Reporting Requirements
The 90-day rule only applies if you meet your obligation as the injured worker to report your injury promptly. However, if an employer does not notify the employee of their rights, the employee may be relieved from the 90-day reporting requirement. Employers are mandated to provide clear written notification of employees’ rights and duties under the workers’ compensation laws.
If the employer fails to comply with notifying employees of the MPN and their rights, the injured worker is relieved from the obligation to treat with designated physicians. Additionally, if an employer fails to comply with notification requirements, they may be relieved from the employee’s notification duty but remain liable for treatment costs.
- You must notify your employer of your injury within 30 days of the incident or from when you first become aware of symptoms.
- The report should be made in writing when possible and include the time, location, and nature of the injury.
- Your employer is then required to give you a DWC-1 claim form, which you must complete and return to formally start the process. Employees must report work-related injuries to their employer within 30 days to avoid losing their benefits. After an injury is reported, the employer must provide a workers’ compensation claim form to complete within one business day.
Failing to report your injury in time can result in your claim being denied entirely, even before the 90-day window begins.
What Happens During the 90-Day Investigation Period?
Once your DWC-1 claim is filed, your employer’s insurance company has 90 days to investigate. During this time, they may: If an employer delays the claim decision, they must continue to cover medical expenses but are not required to pay temporary disability benefits until the claim is accepted.
- Review accident reports or surveillance footage
- Request statements from you or witnesses
- Ask for an independent medical evaluation
- Examine your job duties and medical history
The insurance adjuster must formally accept or deny your claim by day 90. If no decision is issued, your injury becomes legally presumed compensable under Labor Code § 5402. State regulations require each MPN to meet access to care standards for common occupational injuries and work-related illnesses. Employers must comply with specific state regulations when establishing their MPN, including having at least six designated healthcare providers.
What Does “Presumed Compensable” Mean?
“Presumed compensable” means that the workers’ comp system now treats your injury as job-related by default. This gives you access to all relevant benefits, including:
Injured workers are entitled to a second opinion if invasive surgery is prescribed by a doctor within the MPN, and this second opinion must also come from a provider on the MPN. Treatment recommended by MPN doctors must comply with evidence-based medical treatment guidelines.
- Full medical treatment
- Temporary or permanent disability payments (wage replacement)
- Mileage reimbursement for medical visits
- Access to vocational rehabilitation, if applicable
While the insurance company may still attempt to deny your claim, they must now present strong evidence to overcome the legal presumption in your favor. In most instances, workers injured at work cannot sue their employers in civil court, even in cases of gross negligence. Injured workers can change their treating physician to a different provider on the MPN if they disagree with the current doctor’s treatment.
Medical Treatment During the First 90 Days
Even before your claim is accepted, California law requires the insurance company to authorize up to $10,000 in medical treatment within the 90-day period. California workers’ compensation law requires that employees receive up to $10,000 in medical care during the claim review period, which lasts up to 90 days. During the claim delay period, employers must furnish up to $10,000 in medical care to the injured worker.
That means:
- You can begin seeing a doctor right away
- You do not have to wait for full claim acceptance
- Treatment costs (up to the $10,000 limit) must be covered
You may be assigned a physician from your employer’s Medical Provider Network (MPN) during this time. An MPN is a group of approved health care providers specializing in work-related and general medical care. After your first visit, you can choose any doctor from the MPN. If your employer lacks an MPN, you may select any Workers’ Compensation–approved doctor after 30 days. After 90 days, you may choose your own doctor by notifying your employer.
Temporary Disability Benefits and Wage Replacement
Here’s an important distinction: during the first 90 days, even if you’re receiving medical care, the insurance company is not required to pay temporary disability benefits (wage replacement) until the claim is officially accepted.
However, if your claim is eventually accepted or deemed compensable under the 90-day rule: Workers’ compensation benefits are designed to provide injured workers with necessary medical treatment and partially replace lost wages during recovery.
- Wage replacement benefits will begin retroactively
- You may be entitled to back pay for lost wages
- Payments are typically two-thirds of your average weekly wage, up to the state maximum
Why the 90-Day Rule Matters
The rule exists to promote: Workers’ compensation is a no-fault system protecting employers from being sued by injured employees. Workers’ compensation insurance is part of the cost of doing business, and employers cannot ask employees to help pay for it.
1. Timely Benefits
Workers shouldn’t wait months for a decision. The 90-day rule sets a firm deadline to prevent delays in medical treatment and compensation.
2. Fairness
Without this rule, employers and insurers could ignore legitimate injuries. The legal presumption ensures your rights don’t depend on their efficiency.
3. Accountability
It forces employers and carriers to act promptly, rather than stalling or hoping workers abandon their claims.
Important Considerations
State Variations
The 90-day rule described here is specific to California law. While other states have similar protections, deadlines, and presumptions vary by jurisdiction. Always consult with a California-based attorney if your injury occurred here.
Medical Provider Choice
Initially, you may need to treat within your employer’s network. But after 90 days, if your claim has been accepted or presumed compensable, you may be able to choose your own doctor. Let your employer know in writing. In most cases, after 90 days from the first visit with a designated provider, injured workers can treat with any provider they choose.
Proof of Filing
Keep a copy of your completed DWC-1 and proof of submission (e.g., time-stamped copy, email confirmation, or certified mail). This protects you if there’s a dispute over whether the 90-day rule was triggered.
How Scher, Bassett & Hames Helps Injured Workers
At Scher, Bassett & Hames, we fight for California workers who are hurt on the job—and ignored by the system. If your claim is delayed, denied, or unfairly handled: It is illegal for an employer to discriminate against an employee for filing a workers’ compensation claim.
- We’ll confirm whether the 90-day rule applies
- Demand the presumption of compensability under Labor Code § 5402
- Recover medical and disability benefits owed to you
- Fight back against insurance company delay tactics
- Protect your long-term rights and health
Free Consultation for California Work Injury Claims
Has your workers’ comp claim gone unanswered for weeks—or even months?
You may be entitled to full benefits under California’s 90-day rule.
Contact Scher, Bassett & Hames at 408-739-5300 for a free consultation. We’ll review your claim, hold the insurance company accountable, and help you get the treatment and compensation you deserve.
Further Reading:
- What Should You Know About Workers’ Compensation Claims in California
- What Benefits Can You Get From Workers’ Compensation in California?
- How Long Does It Take for a Workers Comp Settlement in California?
- How Much Are California Workers’ Compensation Settlements?
Resources:
- California Department of Industrial Relations – Workers’ Compensation Overview
- Download the DWC-1 Claim Form
- California Labor Code § 5402
