Getting hurt at work is stressful enough. You’re in pain, you might be missing work, and now you’re trying to figure out how to file a workers’ comp claim. In California, there’s something called the “90-day rule,” and it plays a big role in how your claim is handled. If you don’t know how it works, you could miss out on benefits you’re entitled to. Here’s what you need to know.
What Happens Right After a Work Injury?
If you’re injured on the job, report it right away. Don’t wait. Under California law, you have 30 days to report a work-related injury to your employer. If you wait longer, your claim could be denied.
After you report the injury, your employer is required to give you a DWC-1 claim form. This form is your official workers’ comp claim. Once you fill it out and return it, the clock starts ticking.
What Does the 90-Day Rule Mean?
Once you submit your claim form, your employer and their insurance company have 90 days to decide if they’re going to approve or deny your workers’ compensation claim. If they don’t make a decision within that 90-day period, your claim is automatically presumed accepted under California law.
That means after 90 days, they can’t just come back and deny it unless they have strong new evidence.
During this time, they can delay your claim for further investigation—but there are rules for that too.
Can You Get Medical Treatment During the 90 Days?
Yes. Even if your claim is under review or delayed, California law says your employer must cover up to $10,000 in medical treatment while they investigate. So you can still see a doctor and get care right away.
Keep in mind, your employer might have a Medical Provider Network (MPN)—a list of doctors you have to choose from. For the first appointment, your employer picks the doctor. After that, if they have an MPN, you can switch to another doctor in that network.
If there’s no MPN, you can pick any doctor who accepts workers’ comp after 30 days.
What’s Covered by Workers’ Comp?
California’s workers’ compensation system covers a wide range of work-related injuries and illnesses. These can include:
- Slip and fall injuries
- Muscle strains or sprains
- Repetitive motion injuries (like carpal tunnel)
- Hearing loss from loud job sites
- Illness from chemical exposure
- Cumulative trauma from repeated stress or use
Even conditions like heart disease or stress-related mental health issues may qualify—especially if your job made them worse.
It also covers illnesses that happen over time, called cumulative trauma, and occupational exposure like breathing in toxic chemicals.
It’s a No-Fault System
Workers’ compensation in California is a no-fault system. That means you don’t need to prove your employer did something wrong. Even if the injury was your fault—or partly your fault—you can still receive benefits.
However, there are limits. You can’t sue your employer for negligence or pain and suffering. In most cases, workers’ comp is your only option for benefits.
What If Your Claim Is Denied?
Sometimes, the insurance company will deny a claim within the 90 days. If that happens, don’t give up. You have the right to fight back. You can request a hearing before a judge and present evidence like medical records or witness statements.
You should also speak with a lawyer who handles workers’ compensation cases. They can guide you through the process and help protect your rights.
Why Deadlines Matter in Workers’ Comp Claims
Timing is a big deal in California workers’ comp cases:
- 30 days to report the injury
- 14 days for the employer or insurer to respond to the claim
- 90 days for the insurance company to make a final decision
- Up to $10,000 in medical care during the decision period
Missing deadlines can mean losing benefits. So don’t delay. Report the injury, fill out the form, and keep copies of everything.
Call Hinden & Breslavsky Today
If you’ve been injured at work in Los Angeles and you’re not sure what to do next, our team is here to help. With over four decades of experience, our attorneys know how to handle delayed claims, denied claims, and everything in between. We’ll fight to make sure you get the care and money you need to recover.
Call us today at (323) 954-1800 for a free consultation. You don’t pay unless we win.