Workers' Comp Claim Under Investigation? What 90 Days Means

“Your claim is under investigation” sounds official. It does not tell you much by itself.

It does not necessarily mean the claim was denied. It does not mean the employer or insurer accepted every claimed injury. It does not automatically mean anyone suspects fraud. And it does not give the claims administrator permission to leave the worker in silence forever.

For an injured California worker, the useful questions are concrete:

• When was the completed DWC-1 claim form filed with the employer?
• Can the worker prove when the employer received it?
• Did the insurance company send a claim-status letter?
• What medical treatment was requested or authorized while the decision was pending?
• What records, statements, or medical evaluations were requested?
• Was the claim accepted, rejected, or still unresolved in writing?

Those dates and documents matter more than the phrase “under investigation.”

This article provides general information, not legal advice or a deadline calculation. The applicable period, trigger date, specialized presumptions, evidence, body parts or conditions claimed, and procedural posture depend on the actual documents and facts.

Reporting the Injury and Filing the DWC-1 Are Not the Same Event

A worker may report an injury to a supervisor, complete an incident report, visit a clinic, or send a text explaining what happened. Those records can matter. But the California Division of Workers' Compensation also tells workers to complete, sign, date, and return the DWC-1 claim form.

That distinction is important because the general clock in Labor Code section 5402 is tied to the date the claim form is filed under section 5401, not automatically to:

• the injury date;
• the first day symptoms appeared;
• the first medical visit;
• a verbal conversation with a supervisor;
• the date a claim number was assigned; or
• the date an insurance adjuster first called.

Do not guess which date controls. Save the completed employee portion of the DWC-1, the employer-completed copy, and proof of delivery. DWC recommends keeping a copy and using a method that creates a record of when the form was sent and received.

If the employer never provided the form, see WCLG's guide on what to save when an injured worker does not receive a DWC-1.

The 14-Day Status Letter Is Not the Final 90-Day Decision

DWC's claim-filing page says the insurance company generally has 14 days to mail a letter telling the worker the status of the claim.

That letter may say the claim is:

• accepted;
• denied;
• delayed or under investigation; or
• awaiting identified information.

A status letter is not useful if it disappears into a kitchen drawer. Save the complete letter, envelope, portal notice, and attachments. Record the date received and compare the claim number, injury date, employer, and body parts or conditions with the DWC-1.

If the letter says more information is needed, identify exactly what is missing. A generic phrase such as “additional investigation” should lead to specific questions:

• Is a recorded statement requested?
• Are employment, schedule, or payroll records missing?
• Is the administrator waiting for the employer's report or witness information?
• Are medical records or a doctor's report outstanding?
• Is there a dispute about when or how the condition arose?
• Is a compensability medical-legal evaluation being requested?
• What is the next stated decision date?

If no status letter arrives, DWC says to contact the insurance company to ask about the claim. Put the follow-up in writing after any phone call.

What the General 90-Day Rule Actually Says

Under the general rule in California Labor Code section 5402, if liability is not rejected within 90 days after the claim form is filed under section 5401, the injury is presumed compensable. The statute says that presumption can be rebutted only by evidence discovered after the 90-day period.

That is important. It is not a safe excuse to sit quietly and wait for “day 91.”

The real file may contain disputes about:

• whether and when the DWC-1 was filed;
• whether the document described the injury or condition now being claimed;
• whether a notice accepted or rejected the whole claim or only part of it;
• whether later-discovered evidence applies;
• whether the worker falls within a specialized statutory presumption; or
• whether another deadline or procedure requires action sooner.

Do not announce that a claim “automatically won” based on a calendar count from a blog post. Get the completed forms, delivery proof, notices, and medical record reviewed.

Some Statutory Presumption Claims Use 75 Days, Not 90

Section 5402 contains a separate rule for specified injuries and illnesses covered by listed public-safety presumptions. For those claims, the statute uses 75 days rather than 90 days.

That exception is one reason a public article should not calculate a worker's personal deadline. The worker's occupation, claimed condition, statutory category, filing facts, and exact documents matter.

For most readers, the practical move is the same: preserve the filing record and obtain advice based on the actual claim, not a number remembered from social media.

Medical Treatment While the Claim Is Pending

Section 5402 also addresses medical treatment while liability remains undecided. It says that, within one working day after the employee files the claim form under section 5401, the employer must authorize treatment consistent with the applicable treatment guidelines and continue treatment until the claim is accepted or rejected. Liability for treatment during that pending period is limited to $10,000.

That does not mean:

• the worker receives $10,000 in cash;
• every treatment request is automatically approved;
• every doctor or facility is authorized;
• every diagnosis or body part is accepted;
• medical-provider-network rules disappear;
• utilization review or other treatment procedures no longer apply; or
• receiving treatment proves the employer accepted the claim.

Section 5402 expressly says treatment furnished during the pending period does not itself create a presumption of employer liability.

Save every referral, appointment notice, treatment request, authorization, utilization-review notice, pharmacy message, work-status slip, bill, and cancellation. If a provider sends a statement or collection notice, WCLG's separate guide explains what workers should save when billed for a California work injury.

What a Claims Investigation May Examine

A claims administrator may investigate whether the alleged injury arose out of and occurred in the course of employment, what body parts or conditions are claimed, and what medical and factual evidence supports the claim.

Depending on the case, the record may include:

• the DWC-1 and incident report;
• employer and supervisor reports;
• witness accounts;
• schedules, timecards, dispatch logs, route records, or job assignments;
• first medical intake history and later reports;
• prior medical records relevant to the claimed condition;
• photographs, video, equipment, or lawful scene documentation;
• job descriptions and physical demands;
• work-status slips and restrictions;
• statements from the worker; and
• a medical-legal evaluation concerning compensability.

Accuracy beats performance. Do not exaggerate, hide prior injuries, guess when memory is uncertain, or sign a statement you have not read. But do not casually provide passwords, unrestricted phone contents, unrelated private records, or documents you are not legally entitled to possess.

If someone requests a recorded statement, broad medical authorization, examination, or large document production, ask what is being requested, by whom, under what claim number, and by what deadline. Keep a copy of everything supplied.

Do Not Ignore a QME or Other Medical-Legal Notice

Labor Code section 4060 addresses medical-legal evaluations used in disputes over whether an injury is compensable. The procedure can differ depending on whether the worker is represented and on the notice received.

A QME-related notice is not just another appointment reminder. It may contain deadlines, panel information, objection rights, and instructions that can affect the medical-legal record.

Save:

• the notice and envelope;
• the date received;
• every panel form or appointment letter;
• the list of records sent to the evaluator;
• interpreter requests and confirmations;
• travel and attendance records;
• the resulting report; and
• any written objection or request for clarification.

Do not miss an examination or choose a procedural response based only on an online checklist. Review the actual notice promptly. WCLG's QME preparation guide explains what to organize before a medical-legal exam.

Build a Pending-Claim Timeline

One page can expose months of fog. Use a table or dated list with these columns:

• Event: injury report, DWC-1 filing, status notice, appointment, records request, statement, evaluation, acceptance, or denial.
• Date: when it happened.
• Sender or recipient: employer, claims administrator, doctor, evaluator, worker, or attorney.
• Proof: signed form, delivery receipt, letter, email, portal timestamp, medical report, or call note.
• What it says: status, missing information, body parts, restrictions, next action, or stated deadline.
• Next step: who owns the follow-up and when.

Start with WCLG's broader workers' compensation documentation guide if the records are scattered across a phone, email account, work app, and paper mail.

If the Stated Period Passes Without a Clear Decision

Do not rely on silence, and do not throw away later correspondence because you believe the claim should already be accepted.

Instead:

1. Get the employee and employer copies of the DWC-1.
2. Confirm the claimed filing or delivery date with proof.
3. Request the current written claim status from the claims administrator.
4. Ask for every acceptance, denial, or delay notice.
5. Identify whether the notice addresses the entire claim or only certain injuries, body parts, or conditions.
6. Preserve medical reports and evidence created before and after the disputed period.
7. Contact a DWC Information and Assistance officer or a California workers' compensation attorney promptly.

If the claim was denied, get the complete denial letter and the stated reasons. The WCLG denied-claim guide explains the next records to organize. A denial is not proof that the worker has no options, but disputing it may require forms, evidence, medical-legal procedure, and deadlines.

Pending-Claim File Checklist

Bring these records to a claim review:

• completed DWC-1 and proof of delivery;
• employer-completed claim-form copy;
• incident report and written injury notice;
• claim number and administrator contact information;
• 14-day status letter and every later delay letter;
• acceptance or denial notice;
• first medical records connecting the condition to work;
• treatment requests, authorizations, UR notices, and appointment history;
• work-status slips and restrictions;
• wage, schedule, and missed-time records;
• witness names and lawful photographs or video;
• every records or statement request and the response;
• QME, AME, or other medical-legal notices and reports;
• envelopes, email headers, portal timestamps, and fax receipts; and
• a dated call and follow-up log.

Do not “clean up” old records by changing them. Keep originals and add a dated correction or explanation when necessary.

Official Sources

• DWC: How to file a claim
• DWC: Frequently asked questions for employees
• California Labor Code section 5401
• California Labor Code section 5402
• California Labor Code section 4060

Talk to WCLG About the Actual Claim Record

If a California workers' compensation claim is under investigation, the useful answer is not “wait 90 days.” The claim may depend on when the DWC-1 was filed, what the status letters say, which injuries or conditions were claimed, what treatment was requested, what evidence was collected, and whether the administrator clearly accepted or rejected liability.

Workers' Compensation Law Group helps injured workers in Downey, the Gateway Cities, Southeast Los Angeles County, and throughout Los Angeles County review claim forms, notices, medical records, investigation requests, treatment delays, and denial issues.

Call Workers' Compensation Law Group or contact WCLG for a free consultation about the documents in your situation. A consultation does not create an attorney-client relationship unless the firm and client enter an agreement. Available rights and benefits depend on the evidence, deadlines, medical findings, employment facts, and procedural history.