If a claim is not denied within 90 days it can only be denied later based on what?

If a claim is not denied within 90 days it can only be denied later based on what?

• A. The presumption is rebuttable only by evidence discovered subsequent to the 90-day period.
• B. The 90-day denial rule means denial can never be after 90 days.
• C. The claim can be denied later only if the injury worsens after 90 days.
• D. The denial can be delayed for any reason at the employer's discretion.

Answer: (A)

The key idea is the 90-day denial rule in California self‑insurance claims. If the employer or insurer doesn’t deny a claim within 90 days, a presumption arises that the claim is compensable and benefits are due. A denial can still happen later, but only if it’s based on evidence that becomes available after that 90‑day period—i.e., the claim is rebutted by information discovered subsequently. This is why the statement that the presumption is rebuttable only by evidence discovered after the 90‑day period is the best choice. The other options misstate the rule: denials cannot never occur after 90 days, denial grounds aren’t limited to injury worsening, and delaying denial for any reason at the employer’s discretion isn’t consistent with the timing and evidence requirements of the rule.

The key idea is the 90-day denial rule in California self‑insurance claims. If the employer or insurer doesn’t deny a claim within 90 days, a presumption arises that the claim is compensable and benefits are due. A denial can still happen later, but only if it’s based on evidence that becomes available after that 90‑day period—i.e., the claim is rebutted by information discovered subsequently. This is why the statement that the presumption is rebuttable only by evidence discovered after the 90‑day period is the best choice. The other options misstate the rule: denials cannot never occur after 90 days, denial grounds aren’t limited to injury worsening, and delaying denial for any reason at the employer’s discretion isn’t consistent with the timing and evidence requirements of the rule.