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 members 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 member 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. Notifications must be submitted online or by mail within 30 days of filing an action or claim, and MUST include the following pursuant to W&I Code Section14124.73(c):
(1) The date of the Medi-Cal member’s injury,
(2) the Medi-Cal member’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.
Please allow 30 days for DHCS to send a letter confirming receipt of the notification.
When the member 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. Use the Online Forms to tell DHCS when treatment ended or a 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 member 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.
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:
· 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.
o Select “Register” to register as an Enrolled User - Allow DHCS 5 business days to create and confirm your new Enrolled User account
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. Contact Information
· Mailing Address for written correspondence:
Department of Health Care Services
Personal Injury Branch - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
· Phone (916) 445-9891