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 beneficiaries who have workers’ compensation claims with employers, insurance companies, or the Workers’ Compensation Appeals Board (WCAB). When a Medi-Cal beneficiary 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
The Medi-Cal beneficiary or personal representative is required by law to report an action or claim in writing to DHCS pursuant to Welfare and Institutions (W&I) Code Section 14124.70 et seq. DHCS also receives workers’ compensation claims information from the Department of Industrial Relations in order to identify Medi-Cal beneficiaries and their claims. If the injured worker is Medi-Cal eligible, DHCS 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.
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 the Special Needs Trust website for further instructions on notifying DHCS’ Special Needs Trust Unit.
DHCS Lien Process: Workers' Compensation
- The Injury/illness is reported to DHCS.
Notification is provided by the Department of Industrial Relations (DIR) or via Online Forms. - DHCS checks to determine if the injured worker is a Medi-Cal member.
If the Injured worker is not a Medi-Cal member, DHCS will not create a workers' compensation case. If the injured worker is a Medi-Cal member, a workers' compensation case is created. - DHCS will order payment data 120 days from the settlement date or final date of treatment, whichever occurs first.
Under Welfare and Institutions 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. DHCS requests payment data (including, but not limited to, Medi-Cal paid services and medications related to the injury) no earlier than 120 days after the settlement date or final date of treatment, to allow for sufficient time for providers to bill Medi-Cal.
- DHCS may order payment data from Managed Care Plan (MCP).
Payment data may be ordered from multiple MCPs if the member is enrolled in multiple plans during the treatment period. DHCS does not store MCP payment data in-house and does not control the MCPs' response time. Typically, a MCP will respond to DHCS' request for records within 120 days, but additional time may be needed. Records may need to be ordered from multiple Independent Physician Associations (IPAs). - Once DHCS receives payment data, a DHCS representative will review and create a lien, if applicable. Per Welfare and Institutions Code section 14124.71, DHCS is authorized to recover the reasonable value of benefits provided on behalf of the beneficiary.
- DHCS will file the applicable lien with the Electronic Adjudication Management System (EAMS) and serve on the required parties.
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:
One-Time Payment – Ideal for Medi-Cal beneficiaries 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.
2. Payment via check – Submit to:
Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit - MS 4720
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 visit the
Frequently Asked Questions. Instructions are provided in Question 11 under the FAQs for Beneficiaries/Attorneys heading.
Contact Information
Online Forms
Notify and update DHCS electronically using the
Online Forms webpage.
Phone Support Unit
The Phone Support Unit provides information to Medi-Cal Beneficiaries pursuing a workers' compensation claim.
Please visit the
Phone Support Unit - Online Inquiries webpage for more information.
Contact Us
You may contact us by phone, by email, and by mail.
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Phone: (916) 445-9891
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Hours of operation: Monday through Friday - 8:00 a.m. to 5:00 p.m., closed from 12:00 p.m. to 1:00 p.m.
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Closed on weekends and State Holidays
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Email:
WC@dhcs.ca.gov
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Mailing address for written correspondence:
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Department of Health Care Services
Third Party Liability and Recovery Division
Workers’ Compensation Unit - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
