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Personal Injury (PI) Program 

Our Mission

The mission of the Personal Injury (PI) program is to recover funds to replenish the Medi-Cal program so it can continue to provide health coverage for members while serving its clients with integrity and efficiency. 

 Who we are

The Personal Injury program is administered by the Department of Health Care Services (DHCS), Casualty Insurance Operations Section. Its goal is to identify and recover funds Medi-Cal paid on behalf of members in personal injury actions such as: auto liability, premises liability, product liability and other tort liability actions. For tort actions involving class action, medical malpractice, or workers' compensation please use the links to the appropriate recovery unit below.

Lien Process

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 pursuant to Welfare and Institutions Code Section 14124.70 et seq. (W&I Code).  Notification, or referral, 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.

If the injured party is Medi-Cal eligible, DHCS will send a Notice of Lien asserting its recovery rights.  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.

Medical providers have up to one year from date of service to submit bills to Medi-Cal for payment.  DHCS has the right to collect for dates of services provided up to the date of settlement.

If all, or a portion of the settlement will be placed into a special needs trust and you have questions, click here to be redirected to the Special Needs Trust Unit.

Paying a Lien 

When you receive our lien amount and are ready to pay the lien, we accept Electronic Fund Transfers (EFT) and checks, but prefer EFT payments. Regardless of which method you use to pay, you will need your DHCS Account Number to ensure payment to the correct account.

If an insurance company cut one payment to you and the Department of Health Care Services, please see the Frequently Asked Questions for more details about how to handle these kinds of situations.

Contact Information

  • Phone (916) 445-9891
  • Mailing Address:
    • Department of Health Care Services
      Third Party Liability and Recovery Division
      Casualty Insurance Section - MS 4720
      P.O. Box 997425
      Sacramento, CA 95899-7425
       
      The fax line is no longer available. Please submit your case information via Online Forms.
 
Last modified on: 3/18/2016 5:01 PM