The 90-day rule under workers’ compensation law in California states that the workers’ compensation insurance carrier must provide a decision on your claim within 90 days of submission. If it is not approved, denied, or extended within 90 days, the claim is automatically approved.The carrier can extend the consideration period. They must send a Notice of Delay advising of the delay’s reason and requesting any information they need to approve or deny the claim.If you have a pending California workers’ compensation claim that has lasted more than 90 days and you have not received a delay notice, acceptance, denial, or payment, you could pursue legal action. A workers’ compensation attorney can fight for your legal right to benefits.
Understanding California’s Workers’ Compensation 90-Day Rule
If you were hurt at work, you can pursue workers’ compensation. California law allows the insurance carrier 90 days to respond to a workers’ compensation claim. If they don’t deny your claim within 90 days, it is automatically accepted.
When assessing a claim, workers’ compensation insurance administrators can:
- Accept the claim
- Deny the claim
- Send a Notice of Delay to request additional information
If you haven’t received notification of acceptance, denial, or delay, or any benefit payments, an employment attorney can help.
Reasons Your Workers’ Comp Claim Could be Delayed in California
Workers’ compensation claims are complicated, especially if your injury is due to extended exposure or repetitive motion at work. Your workers’ comp carrier could delay your claim decision if:
- The insurance carrier didn’t receive all the proper forms.
- The forms were incomplete.
- Your claim was submitted outside the one-year statute of limitations.
- Your medical records and physician assessments don’t provide sufficient information about the cause, extent, or severity of your injuries.
- It is unclear whether your injuries or illness are work-related.
- Your treatment plan is not consistent with California’s Medical Treatment Utilization Schedule (MTUS).
- The insurance company needs more details about how and where the injury or illness happened.
Workers’ Compensation Benefits You Can Claim in California
In California, workers’ compensation benefits cover work-related injury expenses, including:
- Medical Care: This covers first aid, hospitalization, medical transportation, doctor’s appointments, medical devices, and other care required to recover from your work injury.
- Temporary Disability: When you cannot return to work due to your injury, you can seek temporary disability benefits, which replace a portion of your lost income while you cannot work.
- Permanent Disability: When your work injury causes permanent impairment, you can seek permanent disability benefits to recover a portion of your lost income.
- Supplemental Job Displacement Benefits: If your permanent disability allows you to work in a different position or career, you can apply for a voucher to cover education, training, licensing, and other vocational rehabilitation costs with an accredited school.
- Death Benefits: If an employee dies because of a work injury, the decedent’s spouse, children, or other dependents can claim death benefits, including burial expenses and regular weekly benefit payments.
Steps to Take When Your Workers Comp Claim is Delayed or Denied
Report your injury to your employer as soon as possible. If you wait longer than 30 days, you may lose workers’ comp benefits. Your employer should provide you with a Workers Compensation Claim Form within one day. Your 90-day wait time begins when you return that form to your employer.
While you wait for a decision, you can:
Continue Medical Treatment
Workers’ compensation insurance is required to cover medical expenses for work-related injuries. In addition, doctors cannot charge you for the medical treatment of a work-related injury. Continue your treatment while you await the decision.
File for EDD Benefits
If your claim is delayed or denied, you can seek relief for lost wages through Disability Insurance (DI), also called EDD benefits. This is part of California’s State Disability Insurance (SDI) program and has strict eligibility requirements, so it is wise to speak with a lawyer familiar with disability and workers’ compensation claims in California before you file.
Hire a Workers’ Compensation Attorney
If your claim is denied by workers’ compensation or your employer declines to file for workers’ compensation, you can appeal the decision through the California Department of Industrial Relations Division of Workers’ Compensation. A workers’ compensation lawyer Los Angeles can help you navigate the appeal process, which includes a trial before a workers’ compensation administrative law judge.
Covering Medical Expenses During a Delayed Workers’ Comp Claim
When you suffer a work-related injury, your employer’s workers’ compensation insurance must pay for your medical treatment. To streamline the process, your employer may send you to a preferred medical provider. You don’t have to continue treatment with this provider, but you should work with a doctor within the Division of Workers’ Compensation’s Medical Provider Network (MPN) until you have reached maximum medical improvement (MMI). Even if workers’ comp denies your claim after a delay, they must pay medical bills you incurred during the delay up to $10,000.If your workers’ compensation claim is unreasonably delayed or refused, the workers’ compensation insurance carrier may face penalties in addition to your regular benefit. California Labor Codes allow employees to file a petition for a penalty for late or refused payments. The petition is heard by the appeals board. During your appeal trial, the board will establish whether a penalty is appropriate and how much the insurance carrier should pay.
Reach Out to Our California Workers’ Compensation Attorneys for a Free Consultation
When you file a workers’ compensation claim in California , you deserve a timely and reasonable decision. The workers’ comp attorneys at KJT Law Group can help. Contact us online or call (818) 507-8525 to learn how the 90-day rule under workers’ compensation law applies to your case. One of our dedicated employment lawyers can review your claim and advise on your next steps.