So You Think You Know the Law…(Answers to the Summer Edition 2011 of Gray Matters)
June 2011
Summer 2011
1. If a plaintiff has received benefits from Medi-Cal and files a lawsuit against someone who may be liable for the plaintiff’s injuries, the plaintiff must give written notice of the lawsuit to Medi-Cal by personal service or registered mail within 30 days of its filing and file proof of such notice in his lawsuit. and the defendant’s liability insurance carrier must also give notice of the lawsuit to Medi-Cal. (True/False)
True: “If either the beneficiary or the director brings an action or claim against such third person or carrier the beneficiary or the director shall within 30 days of filing the action give to the other written notice by personal service or registered mail of the action or claim, and of the name of the court or state or local agency in which the action or claim is brought. Proof of such notice shall be filed in such action or claim. If an action or claim is brought by either the director or the beneficiary, the other may, at any time before trial on the facts, become a party to, or shall consolidate his action or claim with the other if brought independently.” Welfare & Institutions Code section 14124.73(a).
“In the event that the beneficiary, his guardian, conservator, personal representative, estate or survivors or any of them brings an action against the third person who may be liable for the injury, notice of institution of legal proceedings, notice of settlement and all other notices required by this code shall be given to the director in Sacramento except in cases where the director specifies that notice shall be given to the Attorney General. All such notices shall be given by insurance carriers, as described in Section 14124.70, having liability for the beneficiary’s claim, and by the attorney retained to assert the beneficiary’s claim, or by the injured party beneficiary, his guardian, conservator, personal representative, estate or survivors, if no attorney is retained.” Welfare & Institutions Code section 14124.79
2. A plaintiff who has received benefits from Medi-Cal and receives a settlement, judgment or award in a lawsuit, does not need to give notice to Medi-Cal for the case outcome to be deemed final or satisfied. (True/False)
False: “No settlement, judgment, or award in any action or claim by a beneficiary to recover damages for injuries, where the director has an interest, shall be deemed final or satisfied without first giving the director notice and a reasonable opportunity to perfect and to satisfy the director’s lien.” Welfare & Institutions Code section 14124.76
3. If a liable defendant’s insurance carrier enters into a settlement of a personal injury claim with a plaintiff who has received benefits from Medi-Cal, the carrier is not required to give notice to Medi-Cal of the settlement. (True/False)
False: “In the event that the beneficiary, his guardian, conservator, personal representative, estate or survivors or any of them brings an action against the third person who may be liable for the injury, notice of institution of legal proceedings, notice of settlement and all other notices required by this code shall be given to the director in Sacramento except in cases where the director specifies that notice shall be given to the Attorney General. All such notices shall be given by insurance carriers, as described in Section 14124.70, having liability for the beneficiary’s claim, and by the attorney retained to assert the beneficiary’s claim, or by the injured party beneficiary, his guardian, conservator, personal representative, estate or survivors, if no attorney is retained.” Welfare & Institutions Code section 14124.79
4. The plaintiff can get a reduction of Medi-Cal’s lien on a personal injury settlement including 25% for attorneys’ fees and a pro-rata share of the costs of litigation. (True/False)
True: “Where the action or claim is brought by the beneficiary alone and the beneficiary incurs a personal liability to pay attorney’s fees and costs of litigation, the director’s claim for reimbursement of the benefits provided to the beneficiary shall be limited to the reasonable value of benefits provided to the beneficiary under the Medi-Cal program less 25 percent which represents the director’s reasonable share of attorney’s fees paid by the beneficiary and that portion of the cost of litigation expenses determined by multiplying by the ratio of the full amount of the reasonable value of benefits so provided to the full amount of the judgment, award, or settlement.” Welfare & Institutions Code § 14124.72(d)
5. A hospital has an automatic lien on a judgment or settlement for the reasonable costs of medical care to a personal injury plaintiff. (True/False)
False: Civil Code § 3045.3 states: A lien shall not be effective, however, unless a written notice containing the name and address of the injured person, the date of the accident, the name and location of the hospital, the amount claimed as reasonable and necessary charges, and the name of each person, firm, or corporation known to the hospital and alleged to be liable to the injured person for the injuries received, is delivered or is mailed by registered mail, return receipt requested, postage prepaid, to each person, firm, or corporation known to the hospital and alleged to be liable to the injured person for the injuries sustained prior to the payment of any moneys to the injured person, his attorney, or legal representative as compensation for the injuries.
The hospital shall, also, deliver or mail by registered mail, return receipt requested, postage prepaid, a copy of the notice to any insurance carrier known to the hospital which has insured the person, firm, or corporation alleged to be liable to the injured person against the liability. The person, firm, or corporation alleged to be liable to the injured person shall, upon request of the hospital, disclose to the hospital the name of the insurance carrier which has insured it against the liability.
If you have any questions or comments do not hesitate to contact me at [email protected].
Please Note: This article is necessarily general in nature and is not a substitute for legal advice with respect to any particular case. Readers should consult with an attorney before taking any action affecting their interests.
