Personal Injury Frequently Asked Questions
Mailing address for payments:
Department of Health Care Services
Third Party Liability and Recovery Division
Personal Injury Branch - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Mailing address for courier mail (UPS, FedEx, etc.):
Department of Health Care Services
Third Party Liability and Recovery Division
1501 Capitol Avenue, MS 4720
Sacramento, CA 95814-5005
Please contact the California Medicaid Management Information Systems (CA-MMIS) Telephone Service Center at (800) 541-5555. They can answer any questions you may have on eligibility, benefits, and your identification card.
You can represent yourself, or you can hire an attorney to represent you. DHCS does not provide assistance in filing claims against other parties.
For faster processing, please report the personal injury accident or claim by using our
Online Forms webpage, "PI Step 1: Report a New Case (Personal Injury Notification Form)."
You can also report by mail:
Department of Health Care Services
Third Party Liability and Recovery Division
Personal Injury Branch - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
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.
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. 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.
As a condition of Medi-Cal eligibility, you agreed that DHCS would receive reimbursement for medical expenditures incurred due to your accident or injury when you receive money from other health insurance, legal settlements, or other sources (liable third party). 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.
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 the liable third party.
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.
DHCS received a notification that you were involved in a personal injury incident and potential third party settlement. The letter informs you that DHCS has the right to assert a lien against any settlement, judgement, or award collected from a liable third party.
(Welfare and Institutions Code sections 14124.70 through 14124.795.)
Welfare and Institutions Code sections 14124.70 - 14124.795
If the injured party is Medi-Cal eligible, DHCS will send a "Notice of Lien" within 30 days of the referral to assert its recovery rights. If the injured party is not currently Medi-Cal eligible, DHCS may send notification stating the Medi-Cal eligibility status will be rechecked for retroactive eligibility in 90 days.
After the Medi-Cal member has completed treatment or reached a settlement, DHCS needs to receive the final date of treatment (FDOT) or the settlement notification to finalize the case and establish a lien, if applicable. DHCS will then send the lien letter with an itemized list of injury-related services to the Medi-Cal member or their personal representative and the liable third party.
I need to talk to someone about my personal injury case. How can I find out who is working my case?
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 state holidays.
You can also use our
online form, "Request the Status of an Open Case" at the bottom of the page.
Please refer to the Personal Injury Program webpage or refer to the
Personal Injury Lien Process for detailed information.
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 using the
online form, under Step 1 "Report a New Case (Personal Injury Notification Form)."
-
If you are an attorney, include with the notification the letter of representation and a signed medical authorization using the
online form. 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 and review the claims payment data to determine the lien.
-
Once your case settles, submit a copy of the signed settlement release using the
online form, under Step 2 "Provide a Case Update or Documentation (All Other Notifications)" so we can apply the appropriate statutory reduction. If you're an attorney, include information about your fees and itemization of litigation expenses.
- Provide the final date of treatment, using the
online form, as soon as possible once the Medi-Cal member has completed treatment.
- For more information about our lien process, please go to
Personal Injury Lien Process webpage.
A preliminary itemization may be requested
online, under Step 2 "Provide a Case Update or Documentation (All Other Notifications)". The request must include proof of hearing, settlement conference, mediation, or similar event and received at least 30 days in advance.
Please refer to DHCS' webpage,
Service of Process, for all the options available for sending a subpoena.
The Medi-Cal program paid for services related to your personal injury incident. DHCS retains the right to collect against any settlement, judgement, or award resulting from your personal injury incident. The amount due stated in the letter shall be paid when you receive money from other health insurance, legal settlements, or other sources (liable third party).
Please contact the provider and provide your Medi-Cal Benefits Identification Card (BIC) information so that they can bill Medi-Cal. Providers have up to 1 year to bill Medi-Cal.
The DHCS' recovery is limited to the amount derived from applying Welfare and Institutions Code section 14124.785. To request a reduction, submit a copy of the settlement release documents along with the attorney's fees and itemized litigation costs using the
online form, under Step 2 "Provide a Case Update or Documentation (All Other Notifications)".
No. The amount of the Medi-Cal lien is due when the case settles.
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 payment is applied to the correct case.
The check should be made payable to Department of Health Care Services. Please include your DHCS Account Number on the payment to ensure timely application to the correct case.
Please mail payments to:
Department of Health Care Services
Third Party Liability and Recovery Division
Personal Injury Branch - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
If you're 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
What happens if the insurance company sends me a check payable to Medi-Cal and me?
If the insurance company issues a check made payable to Medi-Cal or DHCS and you, 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 usually takes up to 60 - 90 days.
-
Pay Medi-Cal's lien amount via cashier’s check, money order, or electronic fund transfer and send us the insurance check for 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.
Please note: DHCS does not endorse a settlement check if Medi-Cal does not have a lien. If DHCS has no interest in an insurance company check, please work with the insurance company to obtain a new check made payable to you. If DHCS has a recoverable interest, we prefer that the insurance carrier issue separate checks—one made payable to DHCS and one made payable to you.
Upon request, DHCS will issue a release letter after the lien amount has been paid in full. If the Medi-Cal lien was paid by check, DHCS will wait 30 days for the check payment to clear the bank before issuing a lien release letter. If you would like a release letter prior to 30 days, you can send a confirmation of the cleared check payment. You also need to provide the settlement information that includes the settlement amount, attorney fees, and litigation costs before DHCS can issue a lien release letter.
When an overpayment is received, a 30-day waiting period is required to ensure that the check payment is not dishonored or returned by the bank. After this waiting period, the refund process typically takes up to 60 business days before the refund check is received by the appropriate party. Please note that the time frame is also dependent on the USPS mail delivery in your area.
The current expedite fee charges are as follows:
- Same Day Issue & Release: $75/payee
- Next Day Release: $50/payee
- Second Day Release: $25/payee
- Third Day Release: $15/payee
- Specific Day Release: $10/payee
Please allow an approximate of 2-3 weeks before you would receive the expedited refund check. The time frame is also dependent on the USPS mail delivery in your area.
Expedite fee payment can be sent through our
Electronic Funds Transfer (EFT) payment system. Payment sent via check will be accepted but will delay the process as refund preparation does not begin until the expedite fee is received.
The following information must be included with the expedite fee payment:
- Case name and/or case number.
- Reason for the payment, i.e., refund expedite fee.
- Timeframe for the expedite, e.g., same day, next day, etc.
- Refund check payee (Name to make the refund check payable to). *
- Mailing address to send the refund check. *
* This information is important to ensure that the refund check is issued correctly and to avoid the refund check from being returned. If the refund check payment is returned, another expedite fee may be required to reissue the check.
Please contact the Phone Support Unit at (916) 445-9891 for more information or to notify PIP about your request. Hours of operation: Monday through Friday, from 8:00 a.m. to 5:00 p.m., closed from 12:00 p.m. – 1:00 p.m. Closed on weekends and state holidays.
Back to Personal Injury Program Page
