The workers’ comp deadlines a California physician owns

Why the kind of day matters

California workers’ comp runs on clocks measured three ways: business days, calendar days and hours. The same practice can owe a report in 20 days, see a UR decision due in five business days and face a 72-hour expedited clock in the same week. Counting a business-day rule in calendar days (or the reverse) is the commonest way a deadline is missed while everyone believes it is being tracked.

Utilization review states its counting rule outright: “The first day in counting any timeframe requirement is the first normal business or working day after receipt of the completed or accepted as complete request for authorization, except when the timeline is measured in hours” (8 CCR §9792.9.3(a)).

Utilization review

Prospective or concurrent decisions: “not to exceed five (5) business days from the date of receipt of the completed request for authorization” (8 CCR §9792.9.3(b)).

Expedited review: “not to exceed 72 hours after the receipt of the written information reasonably necessary to make the determination,” and the requesting physician must certify and document the need for expedited review when submitting (§9792.9.3(c)).

Retrospective decisions: within 30 days of receipt of the request and the information needed to decide it (§9792.9.3(d)).

These timeframes moved. Since 1 April 2026 they sit in §9792.9.3; older forms and software that cite §9792.9.1 for the clocks are citing a section that no longer contains them.

Treating-physician reports

The Doctor’s First Report (Form 5021) is due “within 5 working days following initial examination” (8 CCR §9785(e)(1)).

A progress report is due within 20 days when, among other things, the worker’s condition changes significantly, the treatment plan changes, the worker can return to work or must leave it, or the worker is released from care (§9785(f)(1)–(5)).

With continuing treatment and no triggering event, a progress report is still due “no later than forty-five days from the last report of any type,” and if an examination occurred it must be signed and transmitted within 20 days of the exam (§9785(f)(8)).

QME and AME reports

A comprehensive medical-legal report must be prepared and submitted within 30 days after the evaluator has seen the employee or otherwise commenced the evaluation (8 CCR §38(a)).

Extensions are requested on QME Form 112, and the evaluator must notify the Medical Director and the parties “not later than 5 days before the initial 30-day period … expires” (§38(c)–(d)). Missing tests or a consultant’s report can justify up to 30 more days; good cause, 15 (§38(c)).

Miss the deadline without an approved extension and either party may request a replacement QME, and neither is liable for the late evaluation unless both waive in writing (§38(b)).

IMR and payment clocks

An IMR application is due within 30 days of service of the UR decision — 10 days where the decision concerns only a drug on the state’s formulary drug list (8 CCR §9792.10.1(a)). See the IMR guide.

Payment clocks run 45 days for medical treatment (Lab. Code §4603.2(b)(2)) and 60 days for medical-legal bills (Lab. Code §4622(a)(1)). See the late-payment guide.

How ChironAI™ OM helps

One deadline engine computes these clocks in business or calendar days as each rule requires, tracks every reporting obligation to the party it must be served on, and flags approaching and overdue items each morning. The physician still decides what is filed and when.