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1059 Chapter 7:Worker guides • Section 1: Multiple program worker guides (07/2026)
Medical billings show a trauma diagnostic code indicating an injury/accident.
PIL staff receives information that a potential claim may exist and no MSC 451 or 451NV is on file. The PIL staff may discover potential personal injury settlement situations from the following sources: • Data matches conducted with Department of Motor Vehicles; • Published lawsuits for personal injuries; • Information from medical provider claims; and • Notifications from the following:
Individuals Attorney
Insurance Adjusters
Coordinated Care Organizations The PIL staff will contact individuals directly requesting completion of forms mailed by the program when information is developed from medical provider claims or from data matches with Department of Motor Vehicles to a completed injury form. If the individual fails to respond, eligibility staff will become involved. PIL staff will: • Advise the local office when an individual who has not filed a claim will be required to do so to maintain eligibility.
When notified, eligibility staff will contact the individual about the need to file a claim. ODHS|OHA staff may contact PIL staff for technical assistance in the claim-filing process.
ODHS|OHA staff will use the www.reportinjury.org web portal to report information to PIL. If the individual uses a MSC-451 or MSC-451NV form staff should scan the form into the individual’s case record. • Determine the amount of ODHS|OHA’s lien, if any. The amount of the lien equals the amount of cash and medical benefits received by or paid for the individual from the date of the injury to:
The date of satisfaction of judgment; OR
The date of payment of the settlement or compromise. • Will notify any CCO that may have a right to ask for a lien assignment. • Will file a lien, if appropriate and resolve any issues with the parties involved., Penalties In the Medicaid program only, the person who refuses to cooperate in identifying and pursuing the third-party resource or asset is ineligible for medical benefits. A non-complying individual may also be personally liable for amounts received under ORS 416.610. The remaining family members, such as the children, continue to be eligible for Medicaid. For all other programs except ERDC and SNAP, the penalty for not pursuing assets is ineligibility for the entire filing group (see OAR 461-120-0330). Penalties end when the individual provides evidence that they are willing to pursue the asset. Special considerations