"My claim is delayed."

The $10,000 almost nobody claims

Labor Code § 5402(c): within one working day after you file the claim form, the employer must authorize treatment for the claimed injury and keep it authorized until liability is determined — limited to $10,000.

This applies while your claim is delayed. It applies while your claim is being investigated. It is not contingent on the claim being accepted.

If you are sitting at home untreated because your claim is "delayed," this is the most important paragraph on this page. Ask for it in writing, cite the section, and keep the request.

The 90-day clock

Labor Code § 5402(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."

And that presumption can only be rebutted by evidence discovered after the 90 days ran out.

If you are a public safety member, your clock is 75 days, not 90

Labor Code § 5402(b)(2) sets a shorter period for the occupational illnesses covered by the presumptions in §§ 3212–3212.85 and 3212.9–3213.2 — cancer, heart trouble, hypertension, pneumonia, tuberculosis, meningitis, bloodborne infectious disease, MRSA, biochemical exposure, and post-traumatic stress, depending on classification.

Note the gap in that range, because it is deliberate. The COVID-19 presumptions at §§ 3212.86–3212.88 sit outside § 5402(b)(2), so a claim under those kept the ordinary 90-day period. Those sections have since been repealed — §§ 3212.87 and 3212.88 each provided that they "shall remain in effect only until January 1, 2024, and as of that date is repealed" — so the gap in the range is now historical rather than live.

For those claims the presumption of compensability attaches at 75 days, and a carrier that has been sitting on your claim for 80 days has already run out of time it did not know it was spending.

The public safety presumptions, condition by condition.Firefighters.Police, deputies and correctional officers.

This is why the filing date has to be documented. A carrier that sits past 90 days has, by statute, largely lost the ability to contest the claim on what it already knew.

What they are actually doing

Ordering medical records. Taking a recorded statement. Sometimes surveillance. Looking for a prior claim, a prior injury to the same body part, or a non-industrial explanation.

On recorded statements: you are generally not required to give one, and if you do, the statement is used to find inconsistencies later. Answer only what is asked, do not guess at dates or distances, and say "I don't remember" when you do not.

What to do

Mark 90 days from your claim form date on a calendar.

Request the § 5402(c) treatment in writing.

Keep every letter. The delay notice, its date, and every one after it.

Get treated. Your own health insurance may cover it in the interim, subject to a lien — but untreated is the worst option.

And check whether temporary disability is owed. If a doctor has taken you off work, TD may be due regardless of the delay status, and late payments carry an automatic 10% under § 4650(d).