First 30 Days of Workers' Comp Treatment: New DWC Report

A new California workers' compensation study has a useful finding and an equally useful warning.

The useful finding: after Senate Bill 1160 took effect, injured workers whose diagnoses called for physical therapy had higher odds of receiving it within 30 days, and the average wait for a first physical-therapy visit declined.

The warning: the law does not mean every treatment requested during the first 30 days after an injury must be approved automatically.

On August 19, 2026, the California Division of Workers' Compensation announced a RAND study of SB 1160's effect on utilization review, or UR. The report gives injured workers a better picture of early treatment. It also makes it important to understand what Labor Code section 4610 actually says, because the details can decide whether a request is exempt from prospective UR.

What the New DWC Report Found

The study used data from January 2017 through January 2024 from two large claims administrators, the Independent Medical Review database, and the Workers' Compensation Information System. According to DWC's release, researchers examined whether SB 1160 changed early UR approval rates, guideline-consistent care, and treatment speed.

DWC highlighted three findings:

• UR approval rates for treatment requests submitted during the first 30 days after injury were above 90 percent both before and after SB 1160 took effect.
• The study found no statistically significant change in those approval rates.
• For workers with diagnoses for which physical therapy is recommended, the odds of receiving physical therapy within 30 days were 13 percent higher after implementation. The average wait for a first physical-therapy visit declined from 13.4 days to 11.9 days.

Those numbers need context. DWC says many routine early treatments were already exempt under prior-authorization programs before SB 1160. The study also examined a defined set of data, not every California claim. A population-level result cannot tell you whether a particular treatment request in your case should be approved.

What Prospective Utilization Review Means

Utilization review is the process used to decide whether requested medical treatment is medically necessary under California's treatment guidelines. Prospective UR reviews treatment before it is provided.

Labor Code section 4610(b) creates a limited path for certain treatment during the 30 days following the initial date of injury to be authorized without prospective UR. The rule applies to dates of injury on or after January 1, 2018.

That sentence is not the whole rule. The treatment generally must satisfy several conditions, including:

• the body part or condition is accepted as compensable by the employer;
• the treatment is addressed by the Medical Treatment Utilization Schedule, or MTUS;
• the treatment is consistent with the MTUS;
• the treatment is provided by an eligible physician, such as a Medical Provider Network physician, health care organization physician, or properly predesignated physician;
• if the worker is not subject to those provider arrangements, the treatment is rendered by an employer-selected physician or facility; and
• the physician submits the required report and a complete Request for Authorization within five days after the worker's initial visit and evaluation.

These conditions matter. The phrase “first 30 days” is not a magic stamp placed on every medical request.

The 30 Days Run From the Injury Date

Section 4610(b) refers to the 30 days following the initial date of injury. It does not describe a new 30-day period starting whenever an adjuster opens the file, a clinic schedules the first appointment, or the employer accepts the claim.

That distinction can become important when:

• a worker reports the injury late;
• the first medical appointment is delayed;
• a cumulative-trauma injury has a disputed injury date;
• the claim or a particular body part remains under investigation;
• the worker is sent outside the applicable medical network; or
• a doctor's RFA is submitted after the early period has passed.

Do not calculate a disputed injury date or legal deadline from a blog post. Preserve the documents showing when the injury occurred, when it was reported, when the claim form was submitted, and when treatment was first requested.

Which Early Treatments May Still Go Through Prospective UR?

Labor Code section 4610(c) lists categories that remain subject to prospective UR during the early period unless the employer authorizes them or they qualify as emergency treatment. The statutory list includes:

• pharmaceuticals that are not expressly exempt from prospective review or authorized by the drug formulary;
• nonemergency inpatient and outpatient surgery, including related presurgical and postsurgical services;
• psychological treatment;
• home health care;
• imaging and radiology other than x-rays;
• durable medical equipment with a combined value over $250 under the official medical fee schedule;
• electrodiagnostic medicine, including electromyography and nerve-conduction studies; and
• other services designated by applicable rules.

This is another reason the slogan “no UR for 30 days” is wrong. Physical therapy may fit the early-treatment framework when the statutory conditions are met. An MRI, nonemergency surgery, or certain medication can be treated differently.

Why Early Treatment Can Still Stall

A treatment delay does not identify its own cause. Before assuming UR denied care, find out where the request stopped.

Possible problems include:

1. No complete RFA was submitted. The doctor may have discussed treatment without sending the required form and supporting records.
2. The claim or body part is not accepted. Section 4610(b) ties the early-treatment rule to an accepted body part or condition.
3. The provider does not fit the rule. Network, predesignation, or employer-selection issues may affect the analysis.
4. The request falls within a statutory exception. Imaging, surgery, psychological care, and other listed services may still require prospective review.
5. The request is not supported as MTUS-consistent. A recommendation and a complete, supported authorization request are not always the same thing.
6. The treatment was authorized but not scheduled. Clinic availability, referrals, transportation, or communication failures can create a separate access problem.
7. The insurer modified or denied the request. A written UR decision may trigger different next steps, including possible Independent Medical Review procedures.

The right response depends on which problem actually occurred. Calling every delay a denial can waste time. Calling every delay “normal” can be just as damaging.

What to Ask the Treating Doctor's Office

If early treatment is not moving, ask specific questions and request written answers when possible:

• What treatment did the physician request?
• Was a DWC Form RFA submitted?
• On what date was it sent?
• Where was it sent?
• Did it include the physician's report and supporting records?
• Is the treatment being requested under the early-treatment provisions of section 4610(b)?
• Did the claims administrator acknowledge, authorize, delay, modify, or deny it?
• If authorized, who is responsible for scheduling it?

A short portal message can be more useful than a vague phone conversation. You are trying to establish what was requested, when it was sent, and what happened next.

For more detail on the request itself, read WCLG's guide to the Request for Authorization.

What Records to Save During the First 30 Days

The first month after a work injury can generate records that later answer disputes about claim status, provider selection, treatment timing, and work restrictions.

Save:

• the DWC-1 claim form and proof you returned it;
• your written injury report;
• claim-acceptance, delay, or denial letters;
• documents identifying accepted and disputed body parts;
• the medical-network notice and provider information;
• the doctor's first report and follow-up reports;
• the RFA and supporting records, if available;
• authorization, delay, modification, or denial notices;
• appointment confirmations and cancellation messages;
• the actual date treatment began;
• work-status slips and restrictions;
• wage records if missed work affects your pay; and
• a simple contact log listing dates, names, and what each person said.

Do not alter medical records or invent missing paperwork. If a document does not exist, record that you requested it and preserve the response.

What the Study Does Not Prove About Your Claim

The DWC announcement reports an improvement in certain physical-therapy measures after SB 1160, but it does not establish that the law caused every observed change. It does not say all early physical therapy must be approved, that every worker received faster care, or that treatment outside physical therapy improved in the same way.

It also does not resolve disputes over:

• whether the injury is work-related;
• which body parts or conditions are accepted;
• whether a provider is properly selected;
• whether a particular request follows the MTUS;
• whether an RFA is complete;
• whether a listed exception applies; or
• whether a missed deadline changes a worker's rights.

Those questions turn on the claim file, medical evidence, current law, and sometimes litigation before the Workers' Compensation Appeals Board.

When to Get Legal Help

Consider getting advice promptly when:

• the claim or injured body part remains disputed;
• the clinic and adjuster disagree about whether an RFA was received;
• early treatment is repeatedly delayed without a clear reason;
• UR modifies or denies treatment and an IMR deadline may apply;
• work restrictions are ignored while care is pending;
• delayed treatment affects temporary disability or wages;
• you are sent between providers without an appointment; or
• the injury date itself is disputed.

A lawyer reviewing the actual file can separate a treatment-authorization issue from a claim-acceptance problem, provider-network dispute, scheduling failure, or missed procedural step.

Sources

• DWC: Report on Senate Bill 1160's impact on utilization review
• California Labor Code section 4610
• DWC: I was injured at work
• RAND report landing page

The DWC release summarizes a RAND study using data from January 2017 through January 2024. Statutes, regulations, agency guidance, and treatment procedures can change. This article was reviewed against the sources above on August 24, 2026.

Talk to WCLG About Delayed Early Treatment

The first 30 days after a work injury can shape the medical record, work restrictions, and the pace of recovery. But section 4610's early-treatment framework has conditions and exceptions. A high statewide approval rate does not explain why care is stalled in one claim.

If you were hurt at work in Downey, the Gateway Cities, Southeast Los Angeles County, or elsewhere in Los Angeles County, Workers' Compensation Law Group can review the claim status, RFA, UR notices, provider records, and treatment timeline. Call WCLG at (562) 608-8870 for a free consultation about your specific situation.