After you file for California workers’ compensation, the insurance company may not accept or deny the case right away. Instead, the claims administrator may use the 90-day window to decide whether your injury qualifies for benefits. Understanding what happens during this time can help you track deadlines, treatment and important notices.
The 90-day timeline begins after you submit a completed DWC-1 to your employer. Your employer should complete its section, give you a copy and send the document to the claims administrator. Generally, they should mail you a written notice within the time limits set by state regulations stating whether the case is accepted, denied or delayed for investigation.
A delay notice is not a denial. It usually means the administrator needs more time to investigate.
Medical care during the investigation
During the investigation, the administrator may look at several details, including:
- Your medical records and treatment notes
- How, when and where the injury happened
- Statements from your employer, supervisor or coworkers
- Whether your condition arose out of and occurred in the course of your employment
You may need a qualified medical evaluation (QME) if a dispute develops over medical issues related to your injury.
State law does not require you to wait for a final decision before receiving care. Within one working day after you file the DWC-1, your employer or the claims administrator must authorize appropriate treatment while the case remains pending. This coverage continues up to $10,000 or until the administrator accepts or denies it.
What happens after the 90-day deadline?
If the administrator does not reject liability within 90 days after you file the DWC-1, California law generally presumes the injury is compensable. This means the claim is treated as covered unless the employer rebuts that presumption with evidence that could not have been found earlier through reasonable diligence.
If the administrator denies your claim during the review period, they may stop authorizing additional treatment. However, you generally do not have to repay the cost of medical care authorized during the investigation.
The 90-day window can feel uncertain, but it follows specific rules. Keep copies of your DWC-1, letters from the administrator and treatment records. Clear documentation can help you understand where things stand while the administrator decides whether to accept, deny or continue investigating.