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The 90-day rule: Labor Code §5402

By the Work Injury Compass editorial team · Last updated November 2026 · How we write and check guides

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When the 90 days start

The clock starts on the date the claim form is filed, which means the date you give the completed DWC-1 employee section to your employer (or mail it), not the day you got hurt or told your supervisor. Your employer must date the form and give you a copy. Keep that copy and write down how and when you delivered it. A form mailed by certified mail or sent by email with a reply is easy to prove. See how to fill out the DWC-1 and how to file a claim.

What happens on day 91

If the claims administrator has not rejected liability by the end of the 90 days, the law presumes the injury is compensable. This is a strong rule: under Labor Code §5402, the presumption can be rebutted "only by evidence discovered subsequent to the 90-day period." In practice, an insurer that sat on a claim for 90 days usually can't deny it later using evidence it could have found by investigating on time, such as interviewing your supervisor, getting your records or sending you to an evaluation.

Some claims have a shorter period. For injuries covered by most of the public-safety presumptions (Labor Code §§3212 to 3212.85 and 3212.9 to 3213.2), the period is 75 days. See first responder presumptions.

$10,000 in medical care while you wait

Within one working day after you file the claim form, the employer must authorize all treatment consistent with the treatment guidelines and keep providing it until the claim is accepted or rejected. Until then, its liability for that treatment is capped at $10,000 (Labor Code §5402). Paying for this treatment is not an admission that the claim is valid.

How to use it:

• Ask the employer or adjuster which doctor or network (MPN) to use, and go.
• If treatment is refused while the claim is pending, put your request in writing and keep a copy.
• If you paid out of pocket or used your own insurance during the pending period, send those bills to the claims administrator. Delay notices are required to tell you to do this (Cal. Code Regs., tit. 8, §9812).

Delay letters ("we need more time")

If the claims administrator can't decide liability within 14 days of learning about the injury, it must send you a written delay notice. The notice has to explain why, what information it needs, and when it expects to decide. It must also tell you that the claim is presumed compensable if not denied within 90 days of the claim form, and that the employer must provide treatment up to $10,000 in the meantime. If the decision date passes, it must send another notice (Cal. Code Regs., tit. 8, §9812(g)).

A delay letter does not extend the 90 days. It's simply notice that the insurer is still investigating.

Separately, if temporary disability is owed, the first payment is generally due within 14 days after the employer knows of the injury and the disability. If entitlement can't be decided by then, the administrator must send a separate notice explaining the delay (Labor Code §4650; tit. 8, §9812).

What to do during the 90 days

• Cooperate reasonably. Answer the adjuster's calls. You can ask for questions in writing. If you have a lawyer, statements go through the lawyer.
• Go to every medical appointment and tell each doctor exactly how it happened.
• Keep a log: date the claim form was filed, every letter, and every call.
• Calendar day 90 (and day 75 if a presumption applies). Our deadline checker can do this for you.
• Watch the one-year limit too. The 90-day rule doesn't replace the deadline to file with the WCAB (see the one-year deadline).

If the claim is denied within 90 days

A timely denial is not the end. You can file an Application for Adjudication with the WCAB, ask for a medical-legal evaluation (a QME) if the dispute is medical, and present your evidence. See what to do if your claim is denied.

If the insurer missed the 90 days

If no denial arrived in time and the insurer is now refusing benefits, the presumption is your strongest argument. Gather proof of the date the claim form was filed and every letter you received. Raising the presumption usually means filing with the WCAB and asking a judge to find the injury compensable. Unreasonable delay in paying benefits can also lead to penalties (Labor Code §5814; see delays and penalties).

Common mistakes

• Telling the employer about the injury but never filing the DWC-1. Without the claim form, the 90-day clock never starts.
• Not keeping a copy of the dated claim form.
• Treating a delay letter as a denial, or a denial as final.
• Assuming accepted means everything is covered. Specific treatment can still go through utilization review (see UR and IMR).

This guide is general information, not legal advice. Every case is different. For free help from the state, call the DWC Information & Assistance unit at 1-800-736-7401.