What Is California Labor Code §5402: the 90-Day Compensability Presumption?

(b) (1) If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division. This presumption is rebuttable only by evidence discovered subsequent to the 90-day period.

What does Labor Code 5402 do?

Labor Code 5402 forces the claims administrator to investigate quickly after the worker files the claim form.

Labor Code 5402 is the rule workers rely on when a carrier delays. Once the completed DWC-1 claim form is filed, the administrator must investigate and accept or reject liability within the statutory window. If it does not, the injury can be presumed compensable.

The statute also gives the worker immediate medical help. Within one working day after the claim form is filed, the employer must authorize treatment for the alleged injury, up to the statutory limit, while liability is being investigated.

The claim form date is the center of the analysis. A stamped copy, email proof, fax confirmation, or employer receipt can decide the fight. Eman Yazdchi is a Certified Specialist in workers' compensation law, certified by the California Board of Legal Specialization, State Bar of California.

When does the 90-day clock start?

The clock starts when the worker files the completed claim form under Labor Code 5401, not simply when pain began.

Many workers think the clock starts on the accident date. Labor Code 5402 ties the presumption period to the filed claim form. That is why getting a copy of the completed DWC-1, with proof of delivery, matters so much.

For most claims, no timely rejection within 90 days means the injury is presumed compensable. For certain covered public-safety presumption injuries, current law uses a 75-day period. Those claims need a more specific review because the shorter clock can change leverage.

What does the presumption actually mean?

If the carrier misses the deadline, it must overcome the presumption with evidence discovered after that period.

The presumption is not just a reminder to answer. It limits the carrier's defense. Evidence that could have been gathered during the investigation window may not defeat the presumption. Evidence discovered later may still be argued, but the carrier's burden is harder.

Workers should keep copies of delay notices, denial letters, claim forms, doctor reports, and all carrier communications. The timeline is often stronger than the argument.

What is the treatment rule?

Labor Code 5402 requires up to $10,000 in authorized treatment during the investigation period.

The medical-care rule is separate from final acceptance. The employer must authorize treatment for the alleged injury while deciding whether to accept or deny. Paying for that early care does not automatically admit liability, but it can get the worker to a doctor before the claim decision is made.

If treatment is not authorized, the worker should document each request, each denial, and any out-of-pocket care. Those records can matter later at the WCAB.

How does Labor Code 5402 fit with other deadlines?

The 5402 clock is separate from worker notice, the DWC-1 form rule, and the one-year WCAB filing deadline.

Labor Code 5400 concerns notice to the employer. Labor Code 5401 concerns the claim form. Labor Code 5405 concerns starting proceedings for benefits. Labor Code 5402 concerns the carrier's response and early treatment after the form is filed.

A clean file tracks all four dates. That keeps the carrier from turning a simple delay into a deadline dispute.