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 correspondence through the mail. Please submit all correspondence via the
WC Online Forms:
Select Step 1 under “Workers’ Compensation” to notify DHCS of a new WC case. You will not be able to attach electronic documents using this form.
Select Step 2 under “Workers’ Compensation” to provide updates and attach electronic copies of supporting documents.
Please note the
WC Online Forms system
will not provide real-time, electronic responses. A team member from the Workers’ Compensation Recovery Program will review the online submission and respond via paper mail
within 5-7 business days.
3. What are the options for submitting payments?
Payment may be submitted via Electronic Funds Transfer (EFT) or by mail.
Make an EFT payment
This is the preferred payment method.
Visit the EPAY website to make a payment. Follow the instructions on the webpage for submitting a payment online.
Make a payment by mail
Send payments to:
Department of Health Care Services
Workers’ Compensation Recovery Program MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
4. What is the mailing address ONLY for payments via courier mail?
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?
In order 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 has been provided to DHCS.
There are two types of payment data: Fee for Service data is retrieved from Claims Detail Reports, accessible internally by DHCS. Encounter data is retrieved by submitting requests to external Managed Care Plans. The majority of Medi-Cal beneficiaries are enrolled in Managed Care Plans. On average, it takes DHCS an additional 120 days from the date the encounters were requested, to receive the actual data from the Plans. If necessary, additional requests for Managed Care data may be submitted after the respective timeframes. 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, 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. For more detailed information, please visit DHCS website at http://www.dhcs.ca.gov. Frequently Asked Questions, including those pertaining to eligibility, are listed in the blue box entitled “Medi-Cal”.
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 beneficiary’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 request, DHCS will issue a release letter after the lien amount has been paid in full.
FAQs for Beneficiaries / 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?
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.
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 beneficiary involved. You must submit separate
WC Online Forms for each injured Medi-Cal beneficiary.
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. What are my rights as an injured worker with workers’ compensation benefits and treatment?
DHCS does not provide legal assistance or recommendations for treatment. For more information regarding your inquiry, you may contact the following entities:
Division of Workers Compensation (DWC)
Public Assistance
Phone: (800) 736-7401
Division of Workers Compensation (DWC)
Physical Address:
1515 Clay Street, 16th Floor
Oakland, CA 94612
Mailing Address:
PO Box 420603
San Francisco, CA 94142
Phone: (510) 622-2861
7. 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.
8. Why do I have to notify Medi-Cal?
The Medi-Cal beneficiary 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.
9. How can I get my case to move faster?
10. Can I get a repayment agreement?
No. The amount of the Medi-Cal lien is due when the case settles.
11. What happens if I received a check from the insurance company made out to Medi-Cal/DHCS and me?
DHCS only endorses checks in which we have a recoverable interest. We prefer that the insurance company issue separate checks – one check made payable to Department of Health Care Services, and another check made payable to you. If the insurance company only issues a joint check, you have three options:
Endorse the check and send it to DHCS. We will cash the check, deduct the Medi-Cal lien amount, and send you a refund for the difference. This process takes up to 60 days.
Pay Medi-Cal's lien amount via cashier’s check, money order, or electronic fund transfer in exchange for our endorsement.
If you are an attorney and listed as one of the payees on the check, send us a completed Letter of Guarantee (Form 4204) along with the check in exchange for our endorsement.
We do not accept checks for endorsement if we have no interest in the payment. If DHCS has no interest in an insurance company check, please work with the insurance company to obtain a new check made out solely in your name.
12. 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?
You may send a subpoena by mail to:
Department of Health Care Services
Office of Legal Services
1501 Capitol Avenue
Sacramento, CA 95814
The subpoena or request for records must be hand-served in person to the paralegal of the day between 8 a.m. and 4 p.m. Monday through Friday. You must include a check or money order for the $15 processing fee at the time of service. The subpoena/request for records will be forwarded to Xerox State Healthcare, LLC, (DHCS’ fiscal intermediary) who is responsible for supplying any and all records to the requesting party. DHCS will ONLY provide a response related to the Medi-Cal lien, if any.
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