How Long Does A Workers’ Compensation Insurance Company Have To Investigate My Claim?
How Long Does the Insurance Company Have to Investigate My Workers’ Comp Claim?
Under California Labor Code Section 5402, the insurance company has 90 days from the date it receives your DWC-1 claim form to accept or deny your claim. During this period, they are required to conduct a good faith investigation—this means contacting your employer, gathering witness statements if needed, reviewing your job duties, and obtaining relevant medical records to determine whether you suffered a work-related injury.
Importantly, you are entitled to receive up to $10,000 in medical treatment while your claim is being reviewed—even before a formal decision is made. This ensures injured workers aren’t left without care during the waiting period. Granted, the insurance company must issue the authorization for the doctor which they often drag their feet on.
However, many insurance companies act quickly to deny claims—sometimes within just a few weeks of the claim being filed. This tactic can sidestep their obligation to fully investigate and may deprive you of the care and benefits you deserve. It’s not uncommon for denials to come prematurely, based on incomplete records or a biased evaluation by a company-selected physician.
But here’s the key:
If the claim is not denied within the 90-day window, it is presumed compensable by law. In other words, the injury is assumed to be work-related, and the burden shifts heavily onto the insurance company if they later try to deny the claim. This presumption is extremely powerful and can dramatically impact the outcome of your case.
The 90-day period begins once the DWC-1 form is submitted to either your employer or their insurance carrier. That’s why it’s critical to document and confirm the delivery of your claim form.
At Lee Partners Law, We Monitor That 90-Day Clock Closely
We don’t let insurance companies drag their feet. From the moment we take on a case, we track the statutory deadlines and push to get claims admitted as quickly as possible. If your case has been denied unfairly—or if you’re still waiting for answers—we’re here to fight back.