​​​​​​Personal Injury Program

About Us

The Department of Health Care Services’ (DHCS) Personal Injury (PI) Program seeks reimbursement for services that Medi-Cal paid on behalf of its beneficiaries who are involved in personal injury actions, such as auto accidents, slip and falls, and premises liability. When a Medi-Cal member receives a settlement, judgment or award from a liable third party as compensation for injuries they incurred, the Personal Injury Program is required by federal and State law to recover funds for any related services paid by Medi-Cal.

For claims involving class action litigation, medical malpractice, or workers’ compensation, use the links below to the appropriate recovery unit.

Lien Process

​The Medi-Cal beneficiary or personal representative is required by law to report an action or claim in writing to DHCS pursuant to Welfare and Institutions (W&I) Code Section 14124.70 et seq. This is the first step to obtain a Medi-Cal lien. Please submit the notification online or by mail within 30 days of filing an action or claim. The notification must include the following pursuant to W&I Code Section14124.73(c):
  1. The date of the Medi-Cal beneficiary’s injury,
  2. the Medi-Cal beneficiary’s Medi-Cal identification number,
  3. the contact information of the liable third party or insurer,​
  4. the contact information of the claims administrator including their claim number, and
  5. the contact information of any defense counsel representing the liable third party or insurer.

DHCS Lien Overview: Personal Injury

  1. Injury is reported to DHCS
    Report via Online Forms.
  2. DHCS checks for Medi-Cal eligibility
    If eligible, a Personal Injury case is established. If ineligible, DHCS sends a "no eligibility letter" to the submitting party.
  3. DHCS checks if the Final Date of Treatment (FDOT) or Settlement Date (SD) is available
    If not, a DHCS Representative will contact the attorney, insurance, or beneficiary to request FDOT/SD. FDOT, SD, and additional case information can be submitted via Online Forms.
  4. Prior to ordering payment data, DHCS will allow 120 days to pass from the FDOT or SD, whichever occurred first.
    Per Welfare and Institutions Code section 14115, providers have up to one year from the date of service to bill Medi-Cal. Providers typically bill Medi-Cal within four months of the date of service.
  5. DHCS orders payment data from Managed Care Plan (MCP)
    Data may be ordered from multiple MCPs if the beneficiary is enrolled in multiple plans during the treatment period. MCPs usually respond to DHCS' request for records within 120 days. However, additional time may be needed when records need to be ordered from multiple Independent Physician Associations (IPAs).
  6. Once payment data arrives, a DHCS Representative will review and create a lien, if applicable.
  7. DHCS will send a "lien" or "no lien" letter to the appropriate parties.
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When the beneficiary has completed treatment or a settlement has occurred, DHCS will order and review the payment records to establish a “lien,” or list of injury related services subject to collection. If not previously provided, please use the Case Update or Additional Documentation (PI) form to inform DHCS when the treatment ended or settlement has occurred. DHCS has the right to recover up to the date of settlement or full resolution of all actions associated with the injury, pursuant to W&I Code Section 14124.785. Upon each settlement, the beneficiary or personal representative is required to notify DHCS so that an updated lien may be prepared pursuant to W&I Code Section 14124.76 and 14124.79. For more information on the lien process and timeframes, visit our Frequently Asked Questions page.
 
If funds will be placed into a special needs trust, please go to the Special Needs Trust website for further instructions on notifying DHCS.

Paying a Lien 

In order to apply a payment to the correct account, the DHCS account number must be included with each payment submission. For your convenience, the following payment options are available:
1. Payment via Electronic Fund Transfers (EFT) – To get started, go to the ​EFT website. Two unique EFT options are available:
 
  • One-Time Payment – Ideal for Medi-Cal members and entities with few claims
  • Enrolled User Payment – Ideal for entities with numerous claims and multiple payments. This option allows users to schedule advance payments and track payment history.
    • Select “Register” to register as an Enrolled User - Allow DHCS 5 business days to create and confirm your new Enrolled User account
  • Additional Information about using EFT
 
2. Payment via check – Submit to:
 
Department of Health Care Services
Personal Injury Branch - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
 
Please reference the DHCS account number on the check and allow 15 to 30 business days for DHCS to receive and apply the payment.
If an insurance company issues a single check with both your name and DHCS listed, please review instructions under item #19 in the Frequently Asked Questions page.

Contact Information

Department of Health Care Services
Personal Injury Branch - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425

  • Phone (916) 445-9891
    • Hours of operation: Monday through Friday - 8:00 a.m. to 5:00 p.m., closed from 12:00 p.m. to 1:00 p.m.
    • Closed on weekends and State Holidays







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Last modified date: 12/15/2022 2:19 PM