While the core function of workers’ compensation is the same across all 50 states, each state establishes rules about how the system works. The 90-day rule in California impacts how long employers can take to respond to a workers’ compensation claim.
What is the 90-day rule and how may it affect your claim?
California workers’ compensation 90-day rule
California law requires workers’ compensation insurers to respond to claims within 14 days of the date claimants submit their claim forms. However, employers can delay decisions on a claim for up to 90 days. During this period, the employer must pay up to $10,000 in medical care; however, employers do not have to pay any lost wages. If the employer fails to decide on a claim within 90 days, the claim is automatically accepted and the employer’s insurance must pay for lost wages, medical bills and other costs related to the work injury.
Reasons employers may delay claims
Workers’ compensation is a no-fault system. You are eligible for coverage as long as your injury or illness is work-related, even if your employer was not negligent. However, your employer may delay your claim if it believes you are ineligible for compensation for one or more reasons:
- The claim is for a pre-existing injury.
- You did not get hurt while performing a job-related activity.
- Your physician’s diagnosis is not accurate.
- You did not report the injury timely.
- You did not seek care when you should have.
California law provides employers and their insurance companies with a 90-day window to investigate claims. However, employers cannot delay or deny claims without a valid reason.