What Is a Delay Letter in a California Workers’ Compensation Case?

A delay letter is a written notice sent by the workers’ compensation insurance company to let an injured worker know that their claim is still under investigation. It does not mean the claim is denied, it means the insurance company has not yet accepted or rejected liability.

Under California law, if the claim is not immediately accepted or denied, the insurance carrier must send a delay letter within 14 days of learning about the injury. This requirement is part of the carrier’s obligation to keep the injured worker informed and in compliance with Labor Code section 5402.

Why Is a Delay Letter Sent?

A delay letter is issued when the insurance company needs more time to gather information before deciding whether to accept or deny the claim. Reasons for a delay can include:

• Reviewing medical records
• Interviewing the injured worker, employer, or witnesses
• Investigating the cause of the injury or illness
• Evaluating whether the injury is related to work
• Checking for pre-existing conditions or prior claims

The insurance company has up to 90 days from the date the claim form (DWC-1) is filed to complete its investigation and make a final decision.

What Must a Delay Letter Include?

A valid delay letter must contain:

• A clear statement that the claim is being delayed
• The specific reason for the delay
• A list of information the insurer still needs to complete its investigation
• A statement confirming that medical treatment up to $10,000 is authorized while the claim is under review
• Contact details for the claims adjuster
• A notice of the worker’s rights under California law

If the letter is missing any of this information, the delay notice may not comply with legal requirements.

Medical Treatment During the Delay Period

Under Labor Code section 5402(c), the insurance company must authorize reasonable and necessary medical treatment, up to $10,000, within one working day of receiving the claim form. This treatment must follow the Medical Treatment Utilization Schedule (MTUS).

Approval of medical care under this rule does not mean the claim has been accepted. It simply allows treatment while the claim is under investigation.

What Happens After the Delay Period?

If the insurance company does not formally deny the claim within 90 days of receiving the claim form, the injury is presumed compensable under Labor Code section 5402(b). This presumption can be rebutted, but only if new evidence shows that the injury was not work-related and that evidence could not have been discovered earlier.

At the end of the delay period, the insurer must either:

• Issue a Notice of Acceptance, confirming the claim is approved
• Issue a Notice of Denial, explaining why the claim is being rejected

If no denial is issued within 90 days, the claim is considered accepted by law unless the case involves certain public safety presumptions, where the timeline may differ.

What Should You Do If You Receive a Delay Letter?

If you receive a delay letter:

• Read it carefully to understand the reason for the delay
• Keep a copy of the letter for your records
• Continue attending any authorized medical appointments
• Respond promptly to requests for information
• Contact a workers’ compensation attorney if you feel the delay is unreasonable or if your care is not being authorized

Get Help If Your Claim Is Delayed

A delay letter can be the start of a complex process. If you are not receiving the medical care you need or are concerned your claim may be denied, legal support can help protect your rights. The Law Offices of Norman J. Homen assists injured workers across California with delay letters, claim denials, and benefit disputes.