The claim, start to finish

In a cumulative traumaCT — Cumulative trauma Injury from repeated exposure over time. The largest injury category in California and the least claimed. or occupational disease claim, the “date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this.” is not the date of the exposure. It is the date you first suffered disability and knew, or should have known, it was work-related. That single rule saves more otherwise-late claims than anything else in the code.

1. 01

   Stage 1 — Report it

   The law gives you 30 days to notify your employer. But § 5402(a) is the safety valve, and it is broad: knowledge of an injury “obtained from any source, on the part of an employer, the employer’s managing agent, superintendent, foreman, or other person in authority” is equivalent to formal notice.

   So a supervisor who saw it happen is notice. A foreman you told at the time is notice. A first-aid log entry is notice. Missing the 30-day window is not automatically fatal, and workers talk themselves out of valid claims over it constantly.

   Report in writing anyway, and keep a copy. Text messages and emails are the best evidence most workers ever generate.

2. 02

   Stage 2 — The claim form

   Your employer must give you a DWC-1 claim form within one working day of learning about the injury. Many do not. You do not have to wait for them. The form is available from the DWCDWC Division of Workers’ Compensation, part of the Department of Industrial Relations. Administers the system. Information Services Center: 1-800-736-7401. directly. Fill out the employee section, sign it, date it, and deliver it — and keep a copy showing the date. That date starts two clocks that matter more than almost anything else in the claim.

   THE 90-DAY PRESUMPTION · § 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 under this division.” — and the presumption can only be rebutted by evidence discovered after the 90 days expired.

   THE $10,000 · § 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. Medical treatment you are entitled to while your claim is being investigated.

   READ THE LIMIT CAREFULLY

   The employer “shall continue to provide the treatment until the date that liability for the claim is accepted or rejected” — so the obligation runs during delay, and a rejection ends it. It is not a fund that survives a denial.

3. 03

   Stage 3 — Accepted, delayed, or denied

   If the claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. cannot decide liability within 14 days after your employer learned of the injury, it must send you a written delay notice within that time; a denial notice is due within 14 days of the decision to deny.

   ACCEPTED

   Benefits begin.

   DELAYED

   A “delay letter,” which is not a denial. Investigation continues, the $10,000 treatment obligation is live, and the 90-day clock is running.

   DENIED

   A denial is not the end of the claim. It is the beginning of the litigated part of it.

4. 04

   Stage 4 — Treatment, and the fight over it

   Medical treatment is controlled by the medical provider networkMPN Medical Provider Network. Your employer’s list of physicians. After the first visit you may switch within it without permission. in most cases, and by the utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. process in all of them. Every request your doctor makes goes to UR. UR either approves it, modifies it, or denies it — and a UR denial can only be appealed through Independent Medical ReviewIMR Independent Medical Review. The appeal from a UR denial. 30 days (10 if the dispute is only over drugs on the MTUS Drug List)., not to a judge, except where the UR decision was late.

   The IMR deadline is 30 days from the UR decision — 10 if the dispute is only over drugs on the MTUSMTUS Medical Treatment Utilization Schedule. California’s treatment guidelines. Four of them — shoulder, elbow, hand/wrist/forearm and traumatic brain injury — were replaced January 2, 2026. Drug List — and it is short and unforgiving.

5. 05

   Stage 5 — The medical-legal evaluation

   When there is a dispute about your injury — causation, extent, apportionmentApportionment Dividing permanent disability between industrial and non-industrial causes. It is to disability, not to findings on an image., permanent disabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week., or whether you can work — it is resolved by a medical-legal evaluation. Represented workers can agree with the defense on an Agreed Medical EvaluatorAME Agreed Medical Evaluator. A physician both sides agree on. Available only to represented workers, and practically very hard to move away from.. Unrepresented workers get a Qualified Medical EvaluatorQME Qualified Medical Evaluator. A state-certified physician who resolves disputes. Unrepresented workers get a panel of three by random draw. panel from a random draw, with a specialty chosen from the request.

   THE DEADLINES THAT RUN IN DAYS

   The QME panel process contains the most consequential deadlines in the entire claim, and they run in days, not months. Missing one can cost you the choice of specialty entirely.

6. 06

   Stage 6 — Permanent and stationary, and the rating

   When your condition stops improving, you are permanent and stationary — the same thing as maximum medical improvement. The evaluator writes a report assigning whole person impairment under the AMA Guides and stating apportionment. That impairment number is run through the 2005 Permanent Disability Rating Schedule — adjusted for your occupation, your age, and (for older injuries) a diminished future earning capacity factor — producing a rating string and a final percentage.

   The rating string is checkable, and it is checked far too rarely.

7. 07

   Stage 7 — Into the litigation track

   File the Application for Adjudication within one year. This opens a case at the Appeals Board and gets you an ADJ number and a district office. Then a Declaration of Readiness to Proceed — a filing by either side saying the case is ready for a conference or a trial.

   8 CCR 10744 · TEN DAYS

   A party served with a DOR who does not object “shall be deemed to have waived any and all objections to proceeding on the issues specified in the declaration, absent extraordinary circumstances.” Ten days. And the waiver is broad.

   Declaration of Readinessfiled by either side

   10 days to object

   Mandatory Settlement Conference10–30 days after the DOR · discovery closes

   if it does not settle

   Trialwithin 75 days of the DOR

   THE MOST IMPORTANT RULE IN THE WHOLE PROCESS · § 5502(d)(3)

   “Discovery shall close on the date of the mandatory settlement conference. Evidence not disclosed or obtained thereafter shall not be admissible unless the proponent of the evidence can demonstrate that it was not available or could not have been discovered by the exercise of due diligence prior to the settlement conference.” Whatever is not on the exhibit list at the MSC generally does not come in at trial.

   THE PRETRIAL CONFERENCE STATEMENT · 8 CCR 10759

   The parties identify the issues, the stipulations, each side’s proposed permanent disability rating, every witness, and every exhibit — with author, date, and title. A missing report, an un-listed witness, a supplemental opinion never obtained — all of it becomes permanent here.

   THE MANDATORY SETTLEMENT CONFERENCE

   The Mandatory Settlement Conference is set 10 to 30 days after the DOR. Most cases resolve here.

   IF IT DOES NOT SETTLE

   Trial is set within 75 days of the DOR.

8. 08

   Stage 8 — Trial, and reconsideration

   Trial before a workers’ compensation judge: testimony, exhibits already disclosed, and argument. The judge issues Findings and Award — or Findings and Order — with an opinion. The law gives 20 days from a final order, decision, or award to petition for reconsideration. Reconsideration is only available from final orders — a non-final order is challenged instead by a Petition for Removal. Filing the wrong one wastes the deadline, and it is a common and expensive error.

   LABOR CODE § 5909, AS AMENDED

   “A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board.” Service of the judge’s report constitutes notice of the transmittal.

   PERIOD THE BOARD’S 60 DAYS RUNS FROM

   1. Before July 2, 2024

      The date of filing

   2. July 2, 2024 onward

      The date a trial judge transmits the case to the Appeals Board — AB 171, with notice to the parties required

   3. July 1, 2026

      AB 171’s sunset date — the day the filing trigger was scheduled to return. SB 171 had not yet been chaptered

   4. July 13, 2026 onward

      Transmittal, with no expiration date — SB 171 (Stats. 2026, ch. 83) struck the sunset and repealed the filing-trigger version

   One open question, stated as a question: SB 171 was chaptered July 13, 2026 — twelve days after the July 1 sunset. Which trigger governed a petition acted on inside that window is not settled. After the Board: a Petition for Writ of Review to the Court of Appeal, within 45 days.

9. 09

   Stage 9 — Settlement

   Two structures, and the choice is permanent. Both require approval by a workers’ compensation judge, who must find the settlement adequate. A judge can and does reject inadequate settlements, including for unrepresented workers — but the judge is working from the record in front of them, which is frequently the defense’s record.

   Stage 9 — Settlement

   STIPULATIONS WITH REQUEST FOR AWARD

   How it pays

   The agreed permanent disability percentage, paid out over time

   Future medical

   Stays open

   Reopening

   Within five years of the date of injury, for new and further disability

   When it is wrong

   Rarely catastrophic

   COMPROMISE AND RELEASE

   How it pays

   One lump sum

   Future medical

   Closes permanently

   Reopening

   The case does not reopen

   When it is wrong

   A prosthesis, an implanted device, a joint that will need revision, ongoing medication, or a progressive condition — without a lifetime cost projection

10. 10

    Stage 10 — After it is over

    New and further disability: if your condition gets worse, the law permits reopening within five years of the date of injury — not five years from the settlement, and not five years from the award. For a worker who settled at year four, that leaves twelve months. The Appeals Board may rescind, alter, or amend an award for good cause within five years of the date of injury. A Compromise and Release generally forecloses this. That is the trade.