Generic Program Elements H. Personal Injury Liens

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Generic Program Elements

H. Personal Injury Liens

Effective 7/1/09

1. Intent

The intent of the personal injury liens program is to identify personal injury settlement situations to recover funds to reimburse Medicaid programs, to comply with federal Medicaid regulations, which require recovery from any liable third-party resource, and to a limited extent, to assist clients in obtaining settlements.

2. Responsibility for Identifying Personal Injury Settlements

Clients are responsible for reporting filing of a claim when they are involved in a vehicle accident or a personal injury situation (within 10 days). If the vehicle accident or personal injury occurred before applying for public assistance, clients must report such a claim at the time of application. Clients must pursue all available resources, including any third-party resource that may be liable. Clients are informed of their reporting responsibility via the SDS 539R.

The Personal Injury Liens Unit (PIL) is responsible for identifying situations where a client may be involved in a vehicle accident or a personal injury situation when the client fails to report such situations.

Local offices are responsible for ensuring client cooperation in completing the DHS 451 or 451NV forms when the client reports a vehicle accident or personal injury.

Forward either the 451 or the 451NV to PIL:

Electronically to: personal.injury@state.or.us (See SPD IM-08-033 for more information on the electronic submission of forms). If the DHS 451 is submitted electronically, a diagram is not necessary in section 13, however section 12 should be completed thoroughly.
Mail to:

Personal Injury Lien Unit
PO Box 14512
Salem Oregon 97309
Fax to: (503)378-3137

3. Sources of Information

Personal injury settlement situations may be discovered by the local office from the following sources:

Information from the client; and
Other sources of information, such as local newspaper articles and citizen phone tips.
MMIS report
Notice from PIL, when any of the following has been discovered:
- Medical billings indicate an injury due to an on-the-job or motor vehicle accident.
- Medical billings show a trauma diagnostic code indicating an injury/accident.
- Personal Injury Liens receives information that a potential claim may exist and no DHS 451 or 451NV is on file.

PIL staff may discover potential personal injury settlement situations from the following sources:

Data matches conducted with Motor Vehicles Department;
Published lawsuits for personal injuries; and
Information from medical provider claims.

PIL staff will contact clients directly requesting additional information. If the client fails to respond, the local staff will become involved.

PIL staff will:

Advise the local office when a client who has not filed a claim will be required to do so to maintain eligibility.
- When notified, local staff will contact the client about the need to file a claim. Local staff may contact PIL staff for technical assistance in the claim-filing process.
- When the client has filed the claim, local staff will photocopy the case record copy of the DHS 451 or DHS 451NV and submit the original to the PIL.
Determine the amount of the Department's lien. The amount of the lien equals the amount of cash and medical benefits received by or paid for client from the date of the injury to:
- The date of satisfaction of judgment; OR
- The date of payment of the settlement or compromise.
Notify the local office that the lien has been settled and the amount released to the client.

4. How Information Is Reported; Forms

Clients report information through the DHS 451 or 451NV forms. Assist the client, as necessary, in completing the forms.

Information about vehicle accidents is reported using the DHS 451.

Information about all other personal injury situations is reported using the DHS 451NV.

5. Penalties

In the Medicaid program, only the person who refuses to cooperate in identifying and pursuing the third party resource or asset is ineligible. The remaining family members, such as children, continue to be eligible for Medicaid.

End the penalty when the client provides evidence that they are willing to cooperate.

461-120-0330

6. Special Considerations

Refer all communications or questions concerning the lien to the Personal Injury Liens Unit staff.
Accept no payment related to the personal injury lien.
Local staff may contact Personal Injury Liens Unit staff for technical assistance in assisting a client in the claim-filing process.

If you have a disability and need a document on this Web site to be provided to you in another format, please contact Donna Zeit at (503) 945-7021. If you know of others who need this accommodation, please let them know it is available.