After a crash: practical steps
Medical liens, Medi-Cal and Medicare after an injury settlement
After a crash settlement in California, hospitals, Medi-Cal and Medicare may seek repayment. A hospital lien is limited to 50 percent of the recovery after prior liens (Civil Code § 3045.4). Medi-Cal must get notice within 30 days of a claim, and Medicare conditional payments must be repaid.
When someone else pays for your injury, the people who already paid your medical bills often have a right to be repaid from that money. Knowing these rules early avoids surprises at settlement. Here are the three that come up most after a crash in Riverside County.
Hospital liens
Under California's Hospital Lien Act, a hospital that treats someone injured in an accident has a lien on the damages that person recovers from the one who caused the injury (Civil Code § 3045.1). Once the hospital sends proper notice, an insurer that pays you without paying the hospital becomes liable to the hospital for the lien, up to what could be paid from 50 percent of the recovery after prior liens (Civil Code § 3045.4). In practice, that 50 percent limit matters: a hospital lien cannot take the whole settlement.
Medi-Cal
If Medi-Cal paid for your crash-related care, the Department of Health Care Services (DHCS) can recover the reasonable value of those benefits from your claim. The key rules in the Welfare and Institutions Code:
- Notice within 30 days: if you bring a claim or lawsuit against the person responsible, you must give DHCS written notice within 30 calendar days of filing, including the injury date and your Medi-Cal ID number (W&I Code § 14124.73). Notices of proceedings and of settlement go to DHCS in Sacramento, from your lawyer and the insurer, or from you if you have no lawyer (W&I Code § 14124.79).
- No final settlement without DHCS: a settlement is not final until DHCS has had notice and a reasonable chance to perfect and satisfy its lien, and recovery is limited to the part of the settlement that represents medical expenses (W&I Code § 14124.76).
- Caps: DHCS can never recover more than you receive after attorney's fees and litigation costs (W&I Code § 14124.78), and its recovery is the least of the statutory formulas once all claims for the injury are resolved (W&I Code § 14124.785).
Medicare
If Medicare paid bills that an at-fault driver's insurer should cover, those are conditional payments, and Medicare must be repaid from the settlement. The federal process, from the Centers for Medicare & Medicaid Services:
| Conditional payment | A conditional payment is a payment Medicare makes for services another payer may be responsible for. It must be repaid to Medicare when a settlement, judgment, award or other payment is made. [source] |
|---|---|
| Reporting the case | When an accident or injury occurs, you must notify the Benefits Coordination & Recovery Center (BCRC); any pending liability case must be reported to the BCRC. [source] |
| Conditional Payment Letter | Within 65 days of the Rights and Responsibilities letter, the BCRC sends a Conditional Payment Letter listing the payments it considers related to the case; the amount is an interim estimate. [source] |
| If already settled | If the case has already settled when it is reported, the BCRC issues a Conditional Payment Notification; you have 30 calendar days to respond, or a demand is issued without any reduction for fees or costs. [source] |
| Disputing charges | Claims unrelated to the case can be disputed with supporting documents by mail, fax or the Medicare Secondary Payer Recovery Portal; allow 45 calendar days for review. [source] |
| Phone | BCRC conditional payment information: 1-855-798-2627. [source] |
Health plans and medical providers
Private health plans may also have repayment rights under the plan's terms, and doctors who treat on a lien basis will expect payment from the settlement. Ask every provider and plan for a written statement of what it claims, and check each item against your records: charges for care unrelated to the crash should come off.
What to do now
- List every provider and every payer (health plan, Medi-Cal, Medicare, auto medical payments coverage).
- If you have Medi-Cal or Medicare and are making a claim, make sure DHCS or the BCRC is notified; your lawyer usually handles this.
- Keep lien notices and payment letters with your claim file.
- Watch your deadlines: generally two years for a lawsuit (Code of Civil Procedure § 335.1) and six months for a claim against a public entity (Government Code § 911.2).
Our Hospital Lien Act page explains the lien statute in more detail.
Every fact on this page links to the official source it came from. We checked each one in September 2026. Agencies change fees and procedures, so confirm with the agency before you go. How we research.
Common questions
Can a hospital lien take my whole settlement?
No. Under Civil Code § 3045.4, a payer's liability to the hospital is limited to what can be satisfied from 50 percent of the recovery after prior liens.
Do I have to tell Medi-Cal about my injury claim?
Yes. Written notice must go to DHCS within 30 calendar days of filing a claim or lawsuit against the responsible party (W&I Code § 14124.73).
How much will Medicare take from my settlement?
Medicare seeks repayment of the conditional payments related to the crash. The BCRC sends a Conditional Payment Letter listing them, and you can dispute unrelated charges. Call the BCRC at 1-855-798-2627 for the current amount.
What if I settle before telling Medicare?
The BCRC issues a Conditional Payment Notification. You have 30 calendar days to respond; otherwise a demand is issued without any reduction for fees or costs.
Related pages
Sources
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