How Long Does an Employer Have to Deny a Workers’ Compensation Claim in California?

Did an employee at your company file for workers’ compensation benefits? Employers—and their insurers and claims administrators—have the right to review the claim and approve or deny it based on the information provided. In general, the deadline to deny a workers’ compensation claim in California is 90 days. Here, our Fresno workers’ compensation defense attorney discusses the key things that employers should know about the deadline during the claims process in California.

Know the Law: California Workers’ Compensation Deadline for Employer Decision

When an employee files for workers’ compensation benefits in California, an employer—and its insurer or claims administrator—should take proactive measures to ensure that the claim is processed in a timely manner. Under Labor Code 5402(b)(1), there is a 90-day deadline to make an initial decision. In some cases, employers/insurers are able to make a decision far more quickly than that. However, in more complicated cases, the full 90 days (or close to it) may be needed to resolve the claim.

Case Law: In the 1994 case of Rodriguez v. WCAB, the Court of Appeal of California for the Second District issued a ruling that helped to clarify how the 90-day deadline applied. In that case, the workers’ compensation claim was denied on the 89th day, but the employee did not receive notice of denial until the 96th day. The court determined that the employer/insurer complied with the deadline. The date that matters in California is the date upon which the decision is made, not the date when the worker actually receives written notice.

What Happens if an Employer Fails to Act in Time? (Presumption of Compensability)

When an employer in California fails to respond to a workers’ compensation claim within the 90-day deadline set by Labor Code 5402(b)(1), there will be major implications. In these cases, there is a ‘Presumption of Compensability.’ In other words, if an employer does not make a decision—whether they are accepting the claim or denying the claim within the required 90 days after the claim form is filed, the law automatically presumes the claim to be valid.

The consequences for employers who miss this deadline are substantial. Not only is the claim presumed valid, but the employer may also face additional legal and financial repercussions. Indeed, they could be liable for any medical treatments and benefits the employee received or should have received during the delay. Employers and insurers defending a workers’ compensation claim should always take a proactive approach. Missing deadlines can cause big issues.

Consult With Our Fresno, CA Workers’ Compensation Defense Lawyer

At Yrulegui & Roberts, our Fresno workers’ compensation defense attorneys go above and beyond to solve problems. If you have any questions about denying workers’ compensation benefits, we are here to help. Reach out to us by phone or contact us online to set up a fully confidential consultation. From our main office in Fresno, we defend workers’ compensation claims throughout the wider surrounding area.