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Workers’ Compensation Recovery Program

About Us 

The Department of Health Care Services’ (DHCS) Workers’ Compensation Recovery Program seeks reimbursement for services that Medi-Cal paid on behalf of its members who have workers’ compensation claims with employers, insurance companies, or the Workers’ Compensation Appeals Board (WCAB). When a Medi-Cal member receives a settlement, judgment or award from a liable third party as compensation for injuries they incurred, the Workers’ Compensation Recovery Program is required by federal and State law to recover funds for any related services paid by Medi-Cal.
For claims involving personal injury, medical malpractice, or class action litigation, use the links below to the appropriate recovery unit.

Lien Process 

DHCS receives workers’ compensation claims information from the Department of Industrial Relations in order to identify Medi-Cal members and their claims. If the injured worker is Medi-Cal eligible, DHCS will send a letter to the insurer and/or member’s representative detailing DHCS’ recovery rights and lien process.
DHCS then orders and reviews the payment records. Medical providers have up to one year from the date of service to submit bills to Medi-Cal for payment. DHCS will confirm all injury-related services have been identified and submit a lien to the appropriate parties. For cases involving the WCAB, the Workers’ Compensation Recovery Program will first attempt to resolve the outstanding lien by submitting the lien documentation to the insurer. If payment is not received within 30 days, the Medi-Cal lien will be filed with the WCAB and served to all parties on record.
Please visit the Department of Industrial Relations website for more information regarding workers’ compensation claims. (Not DHCS)
If funds will be placed into a Special Needs Trust, please go to their website for further instructions on notifying DHCS’ Special Needs Trust Unit.

Paying a Lien 

In order to apply a payment to the correct account, the DHCS account number must be included with each payment submission. For your convenience, the following payment options are available:

1. Payment via Electronic Fund Transfers (EFT) – To get started go to the EFT website to get started. Two unique EFT options are available to suit your needs:
·         One-Time Payment – Ideal for Medi-Cal members and entities with few claims
·         Enrolled User Payment – Ideal for entities with numerous claims and multiple payments. This option allows users to schedule advance payments and track payment history.
o    Select “Register” to register as an Enrolled User - Allow DHCS 5 business days to create and confirm your new Enrolled User account
2. Payment via check – Submit to:
Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Please reference the DHCS account number on the check and allow 15 to 30 business days for DHCS to receive and apply the payment.
If an insurance company issues a single check with both you and DHCS listed, please review instructions under item #19 in the Frequently Asked Questions.

Contact Information

·         Online Forms – notify and update DHCS electronically!
 
·         Email Address: WC@dhcs.ca.gov
·         Mailing Address for written correspondence:
 
Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
·         Phone (916) 445-9891

 

Last modified on: 11/15/2017 10:45 AM