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
For faster processing, please report the third party tort action or claim by using the "Step 1: Report a New Case(First Notification Only)" form located on the Online Forms webpage.
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
Please refer to DHCS' webpage,
Service of Process, for all the options available for sending a subpoena.
You can represent yourself, or you can hire an attorney to represent you. DHCS does not provide assistance in filing claims against other parties.
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.
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.
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 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.
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.
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.
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 eligibility 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.
Please refer to the
Personal Injury Program webpage under "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.
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Notify us using the
online form.
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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.
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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.
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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 once the Medi-Cal member has completed treatment.
- For more information about our lien process, please go to
Personal Injury Program webpage.
A preliminary itemization may be requested online. The request must include proof of hearing, settlement conference, mediation, or similar event and received at least 30 days in advance.
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.
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 proper posting.
The check should be made payable to Department of Health Care Services.
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
Please include your DHCS Account Number on the payment to ensure proper posting.
If the insurance company issues a check made payable to you and DHCS, you have three options:
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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.
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Pay Medi-Cal's lien amount via cashier’s check, money order, or electronic fund transfer in exchange for our endorsement.
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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 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 to you. If DHCS has a recoverable interest, we prefer that the insurance carrier issue separate checks—one made payable to the Department 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 before issuing a lien release letter. If you would like a release letter prior to 30 days, you can send a confirming of the cleared payment.
Welfare and Institutions Code sections 14124.70 - 14124.795
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.
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
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 Program Support Unit at (916) 445-9891 for more information or to notify PIP about your request. (Hours of operation is Monday – Friday from 8:00 a.m. to 5:00 p.m., closed from 12:00 NN – 1:00 p.m. Closed on weekends and holidays.)
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