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Personal Injury FAQs

1. Q. How can I contact the Department of Health Care Services (DHCS) Personal Injury program by phone?
A.        Phone Support Unit:
            (916) 445-9891
 
            Operating Hours:  8 a.m. – 12 p.m. and 1 p.m. – 5 p.m. Monday through Friday.
            Closed on weekends and holidays.
           
 
2. Q. What is the mailing address?

A.       Mailing address for written correspondence:

Department of Health Care Services
Third Party Liability and Recovery Division
Casualty Insurance Operations - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425

 

Mailing address for payments:

Department of Health Care Services
Third Party Liability and Recovery Division
Casualty Insurance Operations - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421

 

Mailing address for courier mail:

Department of Health Care Services
Third Party Liability and Recovery Division
1501 Capitol Avenue, MS 4720
Sacramento, CA 95814-5005

  
3. Q. I have been injured and I am taking action against the responsible party.  How do I notify Medi-Cal and what information is needed?
A.        For faster processing, please report the third party tort action or claim through the online form located at: Step 1: Personal Injury Notification
 
You can also report by mail to:
 
Department of Health Care Services
Third Party Liability and Recovery Division
Casualty Insurance Operations - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
 
4. Q. 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?
A.        Department of Health Care Services
Office of Legal Services
1501 Capitol Avenue – MS 0010
Sacramento, CA 95814
5. Q. I have been in an accident. Who can help me?
A.        You can represent yourself, or you can hire an attorney to represent you.  DHCS does not provide assistance in filing claims against other parties.
6. Q. I was involved in an accident involving more than one Medi-Cal member.  Does DHCS need to know about each of them?

A.        Yes, DHCS requires notification of each Medi-Cal member involved. You may submit a separate form for each Medi-Cal member online or by mail.

7. Q. Is telling my county worker about my involvement in an accident sufficient notice?
A.        No.  Welfare and Institutions Code Section 14124.73 requires you or your representative to notify DHCS in writing within 30 days of filing an action against a third party.
8. Q. Why do I have to notify Medi-Cal?
A.        The Medi-Cal member or personal representative is required by law to report the third party tort action or claim in writing to the Department of Health Care Services (DHCS) pursuant to Welfare and Institutions Code Section 14124.73 et seq. (W&I Code).  Notification must be submitted online or by mail within 30 days of filing a personal injury action or claim. Attorneys must submit a Medical Authorization form signed by their client.
            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. Q. What happens if I don’t notify Medi-Cal?
A.        As a condition of Medi-Cal eligibility, you agreed that DHCS would receive any medical payments you receive from private health insurance or other sources (third party liability) to repay the Medi-Cal program for benefits provided due to your accident or injury.  If you do not notify DHCS of your accident or injury, DHCS can take legal action against you to collect the cost of the medical services you received.
10. Q. Does an insurance carrier have to notify Medi-Cal?
A.        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.
11. Q. I need to talk to someone about my personal injury case. How can I find out who is working my case?
A.        To request information about your case or to speak with a live representative, please call our Phone Support Unit at (916) 445-9891. The operating hours are  8 a.m. to 12 p.m. and 1 p.m. to 5 p.m. Monday through Friday. The Phone Support Unit is closed on weekends and holidays.
 
12. Q. After I refer a case, how long will it take for Medi-Cal to respond?
A.        If the injured party is Medi-Cal eligible, DHCS will send a Notice of Lien asserting its recovery rights within 30 days of the referral.  If the injured party is not currently Medi-Cal eligible, DHCS may send notification stating the Medi-Cal status will be rechecked for retroactive eligibility in 90 days.
After the Medi-Cal member has completed treatment or reached a settlement and this information is received, DHCS will review the payment records and establish a lien.  The lien with an itemized list of injury-related services will be sent to the Medi-Cal member or personal representative and the liable third party.
13. Q. Why does it take so long to prepare a lien? What is the process to get a lien ready?
A.        Medical providers have up to one year to submit billing to Medi-Cal for payment. Once the provider bills have been submitted and payment records have been received, DHCS will review the payment data and select the injury-related services to initiate the lien.
14. Q. How can I get my case to move faster?

A.        There are several things that you can do to reduce the time it takes to process a case:
      • Notify us within 30 days of taking an action or filing a claim.
      • Notify us using the online form.
      • If you are an attorney, send a letter of representation and a signed medical authorization. This will allow our office to speak with you regarding this case.
      • 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 treatment data for the lien.
      • When your case settles, submit a copy of the settlement release, so we can calculate the payable lien amount. If you're an attorney, include itemizations for your fees and litigation expenses.
      • Notify us as soon as possible after the Medi-Cal member has completed treatment.
 
15. Q. Personal injury program has imposed a lien on my settlement.  Can I get a reduction?
A.        There are three sections of the Welfare and Institutions (W&I) Code that allow for a reduction of a lien. The director's recovery is limited to the amount derived from applying Sections 14124.72, 14124.76, and 14124.78. whichever is less. To grant a reduction, we may need a copy of the settlement release documents along with itemized attorney's fees and litigation costs.
16. Q. Can I get a repayment agreement?

A.        No. The amount of the Medi-Cal lien is due when the case settles.
17. Q. Can we pay a lien via Electronic Fund Transfer (EFT)?

A.        Yes, we prefer electronic payments over checks and other forms of payment.  Please use our Electronic Funds Transfer payment system.

**Please have your DHCS Account number available to ensure proper posting.**

18. Q. Where do I send a check and whom do I make the check out to?

A.        The check should be made payable to Department of Health Care Services.
Mail to:
Department of Health Care Services
Casualty Insurance Operations, MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
If using courier mail (FedEx, UPS, etc.), please mail to:

Department of Health Care Services
Third Party Liability and Recovery Division
1501 Capitol Avenue, MS 4720
Sacramento, CA 95814-5005

**Please include your DHCS Account Number on the payment to ensure proper posting.**
19. Q. What happens if the insurance company sends me a check made out to me and Medi-Cal?
A.        First, the Department of Health Care Services 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 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're 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 the Department of Health Care Services has no interest in an insurance company check, please work with the insurance company to obtain a new check made out to you.
20. Q. How can I get a letter releasing Medi-Cal’s lien?
A.        Upon request, DHCS will issue a release letter after the lien amount has been paid in full.
21. Q. What laws govern the Personal Injury program?
 
Last modified on: 3/23/2017 3:41 PM