Following a job-related injury, medical bills and other expenses can quickly pile up. Ideally, workers’ compensation benefits would quickly begin covering those expenses, but your employer or the insurance provider can temporarily leave you with those bills. You may be asking yourself, “What is the 90-day rule for workers’ comp in California?”
Fortunately, workers’ comp laws have established protections for your access to workers’ compensation benefits. If someone is denying your lawful requests for compensation, a state workers’ compensation attorney can assert your rights. The lawyers with English Lloyd & Armenta have helped many clients obtain the workers’ compensation benefits they are entitled to.
What Is the 90-Day Rule for Workers’ Compensation?
Every state manages workers’ compensation differently. In California, all employers must comply with state Labour Code Section 3700 by providing workers’ compensation insurance for workers.
Once you file a workers’ compensation claim, your employer is required to facilitate the application process by submitting the form to the insurance provider in a timely manner. Workers’ compensation insurance providers are required to respond to a claim within 14 days, but your employer has the option of delaying your claim.
If your employer does not accept or deny the claim within the specified time limit, then your injury or illness is presumed to be work-related. This will allow you to be eligible for benefits. While you are waiting for the claims adjuster to approve your claim, you can undergo treatments for your injuries as long as they are recommended by a medical doctor and qualify under the state program.
When your claim is approved, you can be reimbursed for these expenses, and further medical treatments will be covered by your workers’ compensation program as long as you work within the program’s guidelines for seeking medical treatment.
Workers’ compensation programs are complicated, and failing to complete certain steps could mean that you are not eligible for reimbursement later. To seek the benefits that you are entitled to, hire a Palm Desert workers’ compensation attorney.
The 90-Day Rule: When Does the Clock Actually Start?
Many workers who have been injured think the 90-day investigation period starts on the date the accident took place. In reality, the timeline begins on the very date you submit a completed DWC-1 claim form to your employer.
In California, the DWC-1 form is the official workers’ compensation claim form. Once you fill out the employee portion of the form and hand it in to your employer, the 90-day period officially begins for the insurance provider to investigate the claim
The DWC-1 Submission Date: Why It Matters
Due to the 90-day timeline being tied to the DWC-1 form and not the accident date, thorough documentation is vital. It would be smart to:
- Keep a copy of the completed DWC-1 form.
- Record the exact date you sent it.
- If possible, submit it in a way that leaves a trail of proof (e.g., email, certified email, or anything that requires written acknowledgement).
The 30-Day Reporting Rule vs. the 90-Day Rule: What’s the Difference?
Another frequent cause of confusion involves two differing timelines in California workers’ compensation law. They are:
- The employee’s requirement to report the injury
- The insurance provider’s obligation to investigate the claim
Under California law, a worker who was injured is typically required to report a workplace injury to their employer within 30 days. The inability to report the injury within said timeframe can affect your ability to receive benefits, unless there are certain circumstances that legitimize the delay. Reporting the injury in a timely manner can enable medical treatment and the processing of the claim to start without needless delays.
After the injury is reported and the DWC-1 form is submitted, the insurer has 90 days to look into the claim. During this period, the provider may:
- Examine medical records.
- Seek further documents.
- Schedule additional medical examinations.
- Decide to either accept or deny the claim.
In California, if the insurance company does not deny the claim within the 90-day period, the claim is usually presumed to be accepted.
The Reason These Two Timelines Are Usually Confused
Each of the aforementioned timelines serves entirely different purposes. The 30-day rule covers the injured employee’s responsibility to report the injury, while the 90-day rule applies to the insurance provider’s responsibility to look into the claim and make a decision. Because the deadlines can impact the outcome of a claim, understanding the difference is crucial.
In 2023, the parts of California outside San Diego, the Bay Area, and the Los Angeles Basin submitted 10% of the state’s cumulative trauma claims. Failing to report an injury on time can cause problems, while delays during the 90-day period of investigation can indicate issues with the handling of the claim.
What Benefits Am I Entitled to Under Workers’ Compensation?
Workers’ compensation benefits are designed to help workers recover from illnesses or injuries they received while on the job. In extreme circumstances, the benefits can support someone who has become disabled due to a work-related injury. The benefits may also provide the survivors of a deceased employee with monetary compensation.
The 90-day rule enables workers to access benefits, even in cases where their employers are delaying the compensation process. With the help of a California workers’ comp attorney, you may be entitled to the following types of benefits.
- Medical treatments. One of the most critical benefits you can receive through the workers’ compensation program is coverage for medical treatment that addresses your work-related injury.
- Temporary disability benefits. Serious injuries can lead to missed time from work. As you recover, workers’ compensation payments can partially make up for lost wages.
- Permanent disability benefits. If you cannot recover completely, permanent disability benefits can help you retrain for a new position. You may also receive long-term benefits if you cannot return to work.
- Death benefits. When an accident leads to death at the workplace, death benefits can cover funeral expenses and payments to surviving relatives and dependents.
Protect Your Claim: Hire a Workers’ Comp Lawyer
If there is any confusion about when your claim was filed or whether deadlines were followed properly, it can be helpful to hire a workers’ comp lawyer to look over your case.
When you retain counsel, they can:
- Confirm whether the 90-day timeline was adequately triggered.
- Find procedural issues or delays.
- Correspond with insurance companies.
- Maintain compliance with California workers’ compensation regulations.
- Keep your rights safe if your claim is delayed or denied.
In 2024, the United States’ average medical lost-time claim severity was $29,600. According to the California Workers’ Compensation Institute, the uphold rate for medical service modifications and denials sits steadily on the edge of 90%. This is why legal counsel can be crucial for your workers’ comp case.
FAQs
How Long Can You Be Out on Workers’ Comp?
You can be off work as long as you need to recover under workers’ compensation in the state, based on the advice of a medical doctor. There are deadlines for benefits, though. Within the first five years of receiving benefits, you will have up to 104 weeks of benefits. You do not have to use this time consecutively. Permanent disability benefits can last much longer.
How Long Does an Employer Have to Hold a Job for Someone on Workers’ Compensation?
Your employer does not have to hold a job for someone on workers’ compensation. However, they cannot retaliate against a person for using their benefits. Doing so violates an array of federal and state laws and regulations. It also opens an employer up to civil liability and regulatory penalties from government agencies.
Can You Be Terminated While on Workers’ Comp?
No employer can retaliate against you for engaging in protected actions, like filing a workers’ compensation claim. Your employer can fire you as long as the termination does not violate your employment contract or state employment law.
If you were unlawfully fired, an employee’s rights lawyer can help you claim monetary damages. If your company must lay off workers for legitimate reasons, you may be legally terminated from your position.
What Is the Maximum Workers’ Comp Benefit?
As of 2026, the maximum weekly payment for employees who receive temporary disability payments depends on their weekly wages. This amount is regularly adjusted upward to keep up with inflation and cost-of-living expenses in the state. The weekly rate for any compensation plan is largely based on the average weekly salary of the employee who files a claim.
Schedule Your California Workers’ Compensation Consultation Today
California’s workers’ compensation program is complicated, and the 90-day rule is just one of many protections that workers have in this state. Enforcing your rights under the workers’ compensation program will be difficult without the help of an attorney who understands employment law.
To schedule your Palm Desert workers’ compensation consultation, contact English Lloyd & Armenta today. We have more than 30 years of experience in helping clients obtain the compensation they deserve.
