Denied & Delayed Claims
Table of Contents
- If your claim is not rejected within 90 days after you file the claim form, the injury is presumed compensable.
- Within one working day after you file a claim form, your employer must authorize medical treatment, up to $10,000 until the claim is accepted or rejected.
- If the insurer delays a decision, it must send a letter explaining why, what information it needs, and when it will decide.
- Payments that are unreasonably delayed or refused can be increased by up to 25 percent or $10,000, whichever is less.
- A denial is not the final word. Disputes can be decided by a workers’ compensation judge.
If your California workers’ comp claim was denied or delayed, it does not mean your case is over. Abramson Labor Group represents injured workers, never employers, in workers’ compensation claims, including denials, delays, and stopped benefits. Our case reviews are free and confidential, and we work on contingency.
Why Injured Workers Choose Abramson Labor Group
- Employees only. We represent injured workers, never employers.
- 4.5 stars across more than 1,900 Google reviews (as of September 2026).
- Documented results. See our case results. Past results do not guarantee a similar outcome.
- Founding partner Zev Abramson founded the firm in 2015 and earned his J.D. at Loyola Law School.
- Help in English and Spanish, with intake also available in Armenian.
What Happens If My Workers’ Comp Claim Is Delayed?
California sets firm timelines for insurers. Under Labor Code section 5402, if liability is not rejected within 90 days after the claim form is filed, “the injury shall be presumed compensable.” The presumption can be rebutted only by “evidence discovered subsequent to the 90-day period.” For certain injuries listed in the statute, the period is 75 days.
While the claim is under review, the employer must authorize treatment within one working day after the claim form is filed, and “liability for medical treatment shall be limited to ten thousand dollars ($10,000)” until the claim is accepted or rejected. According to the Division of Workers’ Compensation, a delay letter must “explain why you won’t receive payments,” what information the claims administrator needs, and when a decision will be made.
| Rule | What the law says | Source |
|---|---|---|
| Decision deadline | Not rejected within 90 days of the claim form: presumed compensable | Labor Code 5402(b) |
| Medical care while pending | Authorized within one working day, up to $10,000 | Labor Code 5402(c) |
| Delay letter | Must explain the reason, the information needed, and when a decision will be made | DWC |
| Unreasonable delay or refusal | Payment increased up to 25 percent or $10,000, whichever is less | Labor Code 5814(a) |
Why Are Workers’ Comp Claims Denied?
Insurers deny claims for many reasons, some valid and many not. These are the reasons we see most often.
- The insurer disputes that the injury happened at work
- The insurer says the injury was reported late
- The insurer blames a pre-existing condition
- The insurer says the medical evidence is not enough
- The claim sits in review with no decision
Disputes over medical evidence can affect every benefit, from temporary disability to permanent disability, return to work benefits, and death benefits. Our workers’ comp benefits overview covers each one, and our article on how workers’ comp works in California explains the claim process.
Can a Denied Claim Be Challenged?
Yes. A denial is the insurer’s position, not a final decision. Disputes can be decided by a workers’ compensation administrative law judge (DWC). A workers’ compensation attorney can evaluate the reason for the denial and the evidence needed to challenge it.
If payments were unreasonably delayed or refused, Labor Code section 5814(a) provides that the amount “shall be increased up to 25 percent or up to ten thousand dollars ($10,000), whichever is less.”
Retaliation after a claim
Being punished for filing a claim can be a separate legal claim. See our article on whether you can be fired for filing workers’ comp in California, our article on workers’ comp and disability, and our workplace injuries page.
Serving Injured Workers Across California
We represent injured workers in Burbank, Glendale, Pasadena, and across Los Angeles County, and statewide through our California employment lawyers.
Frequently Asked Questions
How much does a workers’ comp lawyer cost?
We work on contingency, so you do not pay anything unless we win. The case evaluation is free. The DWC notes that “your attorney can’t directly charge you for his or her services” (DWC). Learn more about how contingency fees work.
My insurer has not decided my claim in 90 days. What does that mean?
If liability is not rejected within 90 days after the claim form is filed, the injury is presumed compensable, with limited exceptions (Labor Code section 5402). The DWC says the claim “is considered accepted in most cases.”
Can I get medical treatment before my claim is accepted?
Yes. The employer must authorize treatment within one working day after the claim form is filed, up to $10,000, until the claim is accepted or rejected (Labor Code section 5402(c)).
Where can I find more answers?
Our California workers’ compensation FAQ answers common questions about claim forms, deadlines, and delays.
Request a Free Case Review
If your claim was denied or your benefits are delayed, we can review the insurer’s decision and explain your options. Request your free case evaluation or call us at (213) 493-6300.
You do not pay ANYTHING unless we win!
Last updated: October 2026
This page is general information about California law, not legal advice. Every situation is different. For advice about your specific case, talk to a licensed California workers’ compensation attorney.