How To Manage A Delayed California Workers’ Compensation Decision

When you’re hurt on the job in California, you expect your workers’ compensation claim to be reviewed and processed quickly. Unfortunately, that’s not always the case. I’ve worked with many clients who waited far too long for a decision, only to be left in pain and without income. 

A delay in your workers’ compensation claim can affect your health, your financial security, and your ability to return to work. While the law gives you the right to medical treatment and temporary disability benefits, those rights are only meaningful if the system functions properly. If your claim has been delayed, it’s important to understand your legal options under California law.

Understanding Time Limits For Workers’ Compensation Decisions

Under California Labor Code § 5402, your employer’s insurance company has 14 days from the date it receives notice of your claim to send you a letter that says liability for your claim has been accepted, delayed, or denied. If the insurance company cannot decide within that time, they are allowed up to 90 days to investigate further. During that 90-day period, a decision affecting liability for the claim is considered “delayed.”

While the insurance company is allowed to investigate, it must still authorize up to $10,000 in medical treatment during the delay period. This means you can begin receiving care for your injury while the claim is pending. If they fail to provide timely care, they may be in violation of California’s workers’ compensation laws.

What A Delay Means For You

A delayed workers’ compensation claim in California does not mean your claim has been denied. It simply means the insurance company is still investigating liability. However, the delay often leaves injured workers in a difficult position. You may be unable to work, unable to afford treatment, and uncertain about when you’ll receive benefits.

Delays are especially frustrating when employers or insurance adjusters don’t communicate clearly. If they miss deadlines, fail to provide written updates, or deny care without proper notice, it could be a sign of bad faith or mismanagement of your claim.

How To Respond When Your Claim Is Delayed

If a claim is delayed, here’s what I generally recommend:

• Confirm that the claim was properly filed. Injured workers should have received a claim form (DWC-1) from their employer. If you didn’t, ask for one immediately.
• Keep all paperwork. Save emails, letters, and medical records. These documents help prove the date of a claim and the steps  taken.
• Seek authorized treatment. If you are injured at work, you are entitled to up to $10,000 in medical care during the investigation period, even if the decision to accept or deny liability for a claim is still delayed.
• File for a hearing if necessary. Injured workers have the right to request a hearing before the California Workers’ Compensation Appeals Board (WCAB) to address unreasonable delays.

If the delay continues beyond 90 days and no decision is made, a claim is presumed accepted under Labor Code § 5402(b). At that point, the insurance company may be ordered responsible for paying all benefits related to a work injury.

When The Delay Is Unreasonable

Not all delays are legal. Under Labor Code § 5814, if the insurance company unreasonably delays or refuses to pay benefits, injured workers may be entitled to a penalty of up to 25% of the amount delayed, plus attorney’s fees under § 5414.5. We’ve seen insurers ignore clear evidence or delay payments without good cause. When that happens, we may file a petition with the WCAB to enforce client rights and seek penalties.

Your Right To Temporary Disability Benefits

If you’re unable to work because of your injury, you may be entitled to temporary disability (TD) payments. These payments replace part of an injured worker’s lost wages while the injured worker recovers. TD benefits are calculated generally as two-thirds of your average weekly wage, up to the state maximum. If your doctor has placed you off work or restricted your duties and your employer cannot accommodate your work restrictions, TD benefits should begin within 14 days of your disability start date.

When your claim is delayed, the insurance company may stall on TD payments. If they fail to pay without explanation, we may be able to step in to make sure your rights under California Labor Code § 4650 are enforced.

Don’t Wait To Get Help

I always tell clients that time matters. The longer we wait to act, the harder it becomes to correct delays or mistakes in a claim. If you’re not getting the medical care or wage replacement you need, legal action may be necessary. We guide our clients through every step of the process—requesting hearings, enforcing benefit payments, and pushing back against unlawful delays.

California Workers’ Compensation Frequently Asked Questions

What Should I Do If My Workers’ Compensation Claim Is Delayed?

Make sure your claim was filed correctly using the DWC-1 form. Keep all written communications, ask for updates in writing, and confirm that the insurer is providing up to $10,000 in medical care while investigating the claim. If the delay goes beyond 90 days, speak with an attorney.

How Long Does The Insurance Company Have To Decide On My Claim?

Under California Labor Code § 5402, the insurance company must respond within 14 days of receiving your claim. If more time is needed to make a decision whether to accept or deny liability for a claim, they have up to 90 days to complete the investigation. After 90 days, liability for the claim is presumed accepted.

Can I Get Medical Treatment During The Delay?

Yes. Even if the insurance company is still investigating your claim, they are required to approve up to $10,000 in medical care under Labor Code § 5402(c). This treatment must be provided without waiting for a final decision. If you are having trouble even accessing medical care, contact an attorney today.

Can I Receive Temporary Disability Benefits While The Claim Is Delayed?

You may be eligible for temporary disability benefits if your doctor has taken you off work or assigned restrictions that your employer cannot accommodate. If liability for your claim is accepted after the delay, benefits may be retroactively paid from the date of disability.

What Happens If The Delay Lasts Longer Than 90 Days?

If the insurance company fails to issue a decision within 90 days, your claim is presumed accepted under California law. The presumption is rebuttable.  This could mean you are legally entitled to full workers’ compensation benefits unless new evidence proves otherwise.

What If The Insurance Company Refuses To Respond?

Silence from the insurer after a claim is filed may be considered bad faith. If they ignore deadlines or fail to provide treatment, you can file a petition with the WCAB. Penalties may also apply for unreasonable delay under Labor Code §§ 5813 & 5814.

Can I Sue My Employer For Delaying My Workers’ Comp Benefits?

Workers’ compensation claims generally prevent you from suing your employer directly.  It is uncommon for such a delay to result in a claim of Workers’ Compensation discrimination, like in a Labor Code §132a claim. However, you can pursue penalties and take legal action against the insurance company through the WCAB for any unreasonable delays or misconduct.

Do I Need A Lawyer If My Claim Is Delayed?

While not required, having a lawyer helps ensure your rights are protected. We understand the 

legal deadlines, medical treatment rules, and how to pressure insurers when they delay your care or benefits.

How Do Penalties For Delay Work In California?

Under Labor Code § 5814, you may be entitled to a penalty of up to 25% of the amount delayed if the delay was unreasonable or in bad faith. This is separate from your regular workers’ compensation benefits.

Is There A Deadline To Challenge A Delay?

There’s no strict deadline to challenge a delay, but waiting too long can hurt your case. If the insurer’s delay affects your health or income, you may wish to speak to an attorney about filing a petition with the WCAB as soon as possible to enforce your rights.

Call A California Workers’ Compensation Attorney You Can Trust

If your workers’ compensation claim has been delayed and you’re not getting the care or income support you need, I’m here to help. At Law Office of Joseph Richards, P.C., we take action onbehalf of clients—filing the right petitions, holding insurance companies accountable, and making sure clients’ legal rights are enforced.

Contact Riverside County workers’ compensation attorney at Law Office of Joseph Richards, P.C. by calling (888) 883-6588 to receive your free consultation. We represent injured workers throughout the entire state of California, and we’re ready to help clients move forward.