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personal injury


									                                                     CONTACT INFORMATION                                 California Department of Health Care Services
                                                                                                       M E D I—C A L P R O G R A M
Q: What    statutory     reduction    does    the
                                                     P   lease refer to the following contacts when
                                                         seeking further information:                 Third Party Liability and Recovery Division

    Department allow for attorney fees and costs?    Personal Injury Unit:
                                                        Department of Health Care Services
A: The Department allows a 25% statutory                Overpayment & Injury Section

    reduction for attorney’s fees and a reduction       MS 4720
    for a pro rata share of the litigation costs        P.O. Box 997425
                                                        Sacramento CA 95899-7425
    when a beneficiary personally incurs a
                                                        Phone: (916) 650-0490
    responsibility to pay them. (Reference W&IC
                                                        Fax:    (916) 650-6581                        INJURY                           UNIT
                                                     Special Collections Unit
Q: Can a Medi-Cal provider file a lien against the      Department of Health Care Services                   INFORMATION PAMPHLET
    settlement?                                         Overpayment & Injury Section
                                                        MS 4720
A: The filing of provider liens in third party          P.O. Box 997425
                                                        Sacramento CA 95899-7425
    actions is no longer allowed once the provider
                                                        Phone: (916) 650-0599 (A—F)
    has billed and been paid by Medi-Cal. W&IC                  (916) 650-0564 (G—O)
    §14127.791 is no longer in effect due to the                (916) 324-0836 (P—Z)
    2003 Appellate Court ruling, Olszewski vs.          Fax:    (916) 650-6581
    Scripps Health.
                                                     Workers’ Compensation:
                                                     Litigated Cases:
                                                         Health Management Systems                    This pamphlet offers a concise overview of the
                                                         9750 Business Park Drive, Suite 110           objectives and polices of the Personal Injury
                                                         Rancho Cordova, CA 95827-1716                     Unit. For those seeking more detailed
                                                         Phone: (916) 760-5100                        information, please contact the Department of
                      Department staff is                Fax:    (916) 854-1850
                      available for informational                                                              Health Care Services directly
                      presentations and/or panel                                                        (See contact numbers on the reverse side).
                                                     Non-Litigated Cases:
                      discussions. Contact the
                                                       Department of Health Care Services
                      Special Collections Unit for
                      further information.             Overpayment & Injury Section
                                                       Workers’ Compensation Unit, MS 4720
                                                       P.O. Box 997425
                                                       Sacramento, CA 95899-7425
                                                       Phone: (916) 650-0490
                                                       Fax:     (916)-650-6584
                                                      PERSONAL INJURY CASES                         Q: Who notifies or makes a referral to the PI
                                                                                                        Unit of a potential third party claim?

PERSONAL INJURY UNIT MISSION                          T   he following constitute the different
                                                          type of personal injury cases:            A: The PI Unit receives referrals from:

T   he Third Party Liability and Recovery Division,
    Overpayment & Injury Section, is responsible
for compliance with state and federal laws and
                                                        Personal Injury Collections
                                                        ♦ Auto Accidents/Uninsured
                                                           Motorist Claims

                                                                                                            Attorneys (W&IC §14124.73, §14124.76,
                                                                                                            and §14124.79
                                                                                                            Insurance Companies (W&IC
regulations governing the                               ♦ Premise/Product Liability                         §14124.795)
Medi-Cal program, with a                                ♦ Medical Malpractice                           ♦   Health Care Providers
primary goal to ensure that                             ♦ Wrongful Death                                ♦   Medi-Cal Managed Care Plans
Medi-Cal is the payer of last                           ♦ Tort Liability Actions                        ♦   Medi-Cal Beneficiaries
resort   for    health    care                                                                          ♦   Other State and Local Agencies
Services provided to Medi-Cal beneficiaries. The        Workers’ Compensation
Personal Injury (PI) Unit identifies and recovers       ♦ Work-related Injuries                     Q: What information is needed to refer a case
Medi-Cal funds expended on behalf of Medi-Cal                                                           to the PI Unit?
beneficiaries involved in personal injury actions.      Special Collections
                                                        ♦ Special Needs Trusts                      A: The following is a list of information
                                                        ♦ Catastrophic Illness and Injury               needed to set up a personal injury case:
                                                        ♦ Class-Actions (i.e. Vaccine Act)
                                                        ♦ Risk Management                               ♦   Beneficiary Name
ACCOMPLISHING THE MISSION                               ♦ Administrative Trust Agreements               ♦   Social Security Number
                                                                                                        ♦   Date of Injury/Dates of Services

      personal injury case is established when        FREQUENTLY ASKED QUESTIONS                        ♦   Provider Names(s)
     the PI Unit receives a referral on a Medi-Cal                                                      ♦   Cause of Injury
     beneficiary and eligibility is confirmed.        Q: Which laws govern the PI Program?              ♦   Nature/Type of Injury
Medi-Cal payment history is then ordered for the                                                        ♦   Attorney Names and Address
period of time from the date of injury to the         A: The rights and responsibilities of the         ♦   Insurance Company Name/Address
present.      The PI Unit staff reviews the               Department of Health Care Services,
beneficiary’s payment data, develops an                   Health   Care      Providers, Insurance   Q: What if the settlement amount is not
itemization of payments containing injury-                Companies, Medi-Cal Beneficiaries and         enough to cover the Medi-Cal Lien?
related services, and asserts a Medi-Cal; lien            their representatives are outlined in
against any settlement, judgment, or award for            Welfare and Institutions Code (W&IC)      A: The Department’s claim for reimbursement
the itemized claim amount.                                §14127.70 through §14127.795. Special         will never exceed what the beneficiary
                                                          needs trusts are referenced in Probate        recovers    after   deducting  from   the
                                                          Code §3600 et seq.                            settlement, judgment or award, attorney’s
                                                                                                        fees and litigation costs paid for by the
                                                                                                        beneficiary. (Reference W&IC §14124.78)

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