Workers' Compensation Frequently Asked Questions
General Frequently Asked Questions (FAQs)
1. How can I contact DHCS’ Workers’ Compensation Recovery Program by phone?
You may contact the Phone Support Unit at
(916) 445-9891.
The operating hours are 8 a.m. – 12 p.m. and 1 p.m. – 5 p.m. Monday through Friday.
Our offices are closed on weekends and state observed holidays.
2.
What is the mailing address for written correspondence?
The Workers’ Compensation Recovery Program
does not
accept case updates through the mail. Please submit all case updates via the
WC Online Forms:
Select Step 1 under “Workers’ Compensation” to notify DHCS of a new Workers' Compensation case or provide an update to an existing case. Please note you will not be able to attach electronic documents using this form.
Other forms of written correspondance may be mailed to:
Department of Health Care Services
Workers' Compensation Recovery Programs MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Please be aware that the
WC Online Forms system
will not provide real-time, electronic responses.
3. What are the options for submitting payments?
The preferred method of payment is via Electronic Funds Transfer (EFT). To make an EFT payment please visit the EPAY website to make a payment. Follow the instructions on the webpage for submitting a payment online.
Payments are also accepted by mail. Please send payments to:
Department of Health Care Services
Workers’ Compensation Recovery Program MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Please include your DHCS Account Number on all forms of payments to ensure your payment is posted tot he correct account.
4. What is the mailing address ONLY for payments via courier mail (FedEx, UPS, etc.)?
Department of Health Care Services
Workers’ Compensation Recovery Program
1501 Capitol Avenue, MS 4720
Sacramento, CA 95814-5005
Please include your DHCS Account Number on the payment to ensure your payment is posted to the correct account.
5. What laws govern the Workers’ Compensation Recovery Program?
Labor Codes 138.7, 3202.5, 4900 et seq.
Title 19, Section 1902, Subsection (a)(25) of the Social Security Act
Title 42, Code of Federal Regulations Part 433.138(d)(4)(i)
Code of Regulations, Title 22, § 53222
Code of Regulations, Title 8
Welfare and Institutions Code Section 14124.70 et seq.
6. Why does it take so long to prepare a lien? What is the process to get a lien ready?
To create a lien for the claimant, payment data needs to be ordered and reviewed by the Workers’ Compensation Recovery Program. DHCS orders payment data 120-days after the final date of treatment or settlement date. Per (W&I) Code
section 14115, providers have up to one year from the date of service to bill
Medi-Cal. Providers typically bill Medi-Cal within four months of the date of
services. By requesting payment data no earlier than 120 days after the last
date of treatment or the settlement date, DHCS is allowing sufficient time for
providers to bill Medi-Cal.
Medi-Cal members are enrolled in Medi-Cal either through what is called “Fee for Service" or a “Managed Care Plan" and there are two types of payment data that correspond with how the Medi-Cal member is enrolled. Fee for Service data is retrieved from Claims Detail Reports, accessible internally by DHCS. “Encounter data" is payment data retrieved by submitting requests to external Managed Care Plans.
Because the majority of Medi-Cal members are enrolled in Managed Care Plans, DHCS must often retrieve “encounter data" from external Managed Care Plans. On average, it takes DHCS an additional 120 days from the date the encounter data was requested, to receive the actual data from the Managed Care Plans. At times it is necessary for DHCS to make additional data requests to Managed Care Plans after the initial data request. This process can cause delays in case review and lien determination procedures.
7. Can a case have both Personal Injury and Workers’ Compensation claims?
Yes, it is possible for a claim to have both Personal Injury and Workers’ Compensation components. Each claim will be analyzed and processed on a case-by-case basis. To ensure proper and accurate lien determination and avoid delays in lien issuance, please advise DHCS promptly of the complete details surrounding each claim. Use the WC Online Forms to notify and update DHCS of a Personal Injury/Workers’ Compensation crossover claim.
All calls regarding Personal Injury and Workers’ Compensation crossover claims can be directed to the Phone Support Unit at (916) 445-9891.
FAQs for Insurance Companies
1. Why does the injured worker have Medi-Cal if they are employed?
Eligibility for the Medi-Cal program is based on the income level of an individual or family member(s) that qualify for free or low-cost health insurance. Please visit DHCS website for more detaqiled information.
2. Does an insurance carrier have to notify Medi-Cal?
Yes. Welfare and Institutions Code Section 14124.79 requires insurance carriers that have liability for a Medi-Cal member’s claim to notify DHCS. Liable third-party insurance carriers are legally obligated to reimburse Medi-Cal for any Medi-Cal paid services related to an injury or illness.
3. How can I get a letter releasing Medi-Cal’s lien?
Upon written request, DHCS will issue a release letter after the lien amount has been paid in full.
FAQs for Members / Attorneys
1. What happens if the lien is not resolved?
When Medi-Cal benefits are provided because of an injury for which another party is liable, the director has a right to recover from such a party or carrier the reasonable value of benefits so provided. DHCS may take legal action against the third party or carrier who may be liable for the injury in an appropriate court. (Welfare & Institutions Code Section 14124.71).
2. I was injured at work or as a result of work-related duties.
How do I notify Medi-Cal? What information is needed?
Please report your claim to DHCS via
WC Online Forms and select Step 1 under "Workers' Compensation" to submit a new notification.
3. I have been in a workers’ compensation accident. Who can help me?
You can represent yourself, or you can hire an attorney to represent you. DHCS does not provide legal assistance. Please visit the
Department of Industrial Relations website for additional information regarding workers’ compensation injuries, benefits, and rights.
4. I was involved in an accident involving more than one Medi-Cal beneficiary. Does DHCS need to know about each of them?
Yes, DHCS requires notification of each Medi-Cal member involved. You must submit separate
WC Online Forms for each injured Medi-Cal member.
5. I need to talk to someone about my workers’ compensation case. How can I find out who is working my case?
To request information about your case, please call our Phone Support Unit at (916) 445-9891.
The operating hours are 8 a.m. – 12 p.m. and 1 p.m. – 5 p.m. Monday through Friday.
Our offices are closed on weekends and state observed holidays.
6. Is telling my county worker about my involvement in an accident sufficient notice?
No. Welfare and Institutions Code Section 14124.73 requires you or your representative to notify DHCS in writing within 30 days of filing a claim or action against a third party.
7. Why do I have to notify Medi-Cal?
The Medi-Cal member or personal representative is required by law to report the third party tort action or claim in writing to DHCS pursuant to Welfare and Institutions Code section 14124.73 et seq. Notification must be submitted via
WC Online Forms.
DHCS is required by law to seek recovery of payments made by Medi-Cal to treat injuries caused by a liable third party. Notification enables DHCS to comply with this legal requirement.
8. How can I get my case to move faster?
There are several things that you can do to reduce the time it takes to process a case:
Notify us using the
WC Online Forms.
If you have an upcoming court or mediation date and need a Medi-Cal lien amount, alert us as soon as you get the date. We will need time to obtain medical payments data for the lien. You may submit the request via the
WC Online Forms.
When your Workers' Compensation case settles, submit a case update via the
WC Online Forms so we can proceed with ordering the necessary medical payment data to prepare the lien.
Notify us as soon as possible via the
WC Online Forms after the Medi-Cal member has completed treatment so we can proceed with ordering the necessary medical payment data to prepare the lien.
9. Can I get a repayment agreement?
No. The amount of the Medi-Cal lien is due when the case settles.
10. I am the plaintiff’s or defense attorney and need to request medical expense records or a personal appearance. Where do I send a subpoena?
Please refer to DHCS' webpage, Service of Process, for all the options available for sending a subpoena.
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