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By Eman Yazdchi, Esq. · Certified Specialist in Workers' Compensation Law, State Bar of California Board of Legal Specialization
In California, Labor Code §5402(b) presumes a workers' compensation claim is compensable if the insurer does not accept or deny within 90 days of the filed DWC-1. Section 5402(c) requires up to $10,000 in immediate treatment. Yazdchi Law, a Certified Specialist in Workers' Compensation Law firm, handles §5402 disputes statewide. Request a free case review.
Under California Labor Code §5402(b), a California workers' compensation insurer must accept or deny the claim within 90 days of receiving the worker's completed DWC-1 form. If the insurer fails to act, the injury is presumed compensable, and the presumption can be rebutted only by evidence discovered after the 90-day window expired. Under California Labor Code §5402(c), the insurer must authorize up to $10,000 in medical treatment within one working day, regardless of whether the claim is ultimately accepted or denied. For the statewide framework, see California workers' comp claim-denied playbook.
Under California Labor Code §5402(b), the 90-day clock starts on the date the insurer receives the worker's completed DWC-1 claim form. If the insurer issues neither an acceptance nor a denial by day 90, the injury is presumed compensable. The presumption shifts the burden to the insurer to come forward with evidence discovered after day 90 to overcome it. Pre-existing evidence — medical records, surveillance, witness statements that existed during the 90-day window — cannot rebut the presumption. Related coverage: California workers' comp appeal pillar.
Under California Labor Code §5402(c), an insurer must authorize medical treatment under California Labor Code §4600 up to a cumulative cost of $10,000 within one working day of the completed DWC-1, regardless of whether the claim is ultimately accepted or denied. The provision exists to prevent treatment delay during the 90-day investigation window. Treatment authorized under §5402(c) does not extinguish the insurer's right to deny the claim later. Related coverage: California Labor Code §5400 (30-day employer notice rule).
California Labor Code §5400 requires the California worker to give the employer notice of the injury within 30 days, and California Labor Code §5401 requires the employer to provide a DWC-1 claim form within one working day. Once the worker returns the completed DWC-1, the insurer's 90-day decision clock under California Labor Code §5402(b) starts. The one-year statute of limitations under California Labor Code §5405 for filing the application with the WCAB runs on its own track. Lea esta página en español: la regla de 90 días del §5402 (versión en español).
The California Supreme Court held in Rodriguez v. WCAB (1994) that the §5402(b) presumption may be rebutted only by evidence discovered after the 90-day window. Evidence that existed during the 90 days but was not investigated — medical records the insurer never requested, witnesses the insurer never interviewed — cannot rebut the presumption. New evidence developed after day 90 (an admission by the worker, a previously unknown injury cause, surveillance taken after day 90) can rebut it. Statute deep-dive: California Labor Code §5405 (one-year filing deadline).
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Tap to call →Last reviewed by Eman Yazdchi, Esq., May 2026.
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