Personal Injury Liens Unit (PIL)
The Personal Injury Liens Unit (PIL) files liens on settlements or court judgments to ensure the state is reimbursed for medical expenses it paid on behalf of the injured individual. The lien is on the amount of the settlement (allocated to medical expenses) made by the person or business that is liable for the injures. The lien can be placed for costs related to medical assistance benefits, including Medicaid or Oregon Health Plan and Temporary Assistance to Needy Families (TANF) benefits.
Individuals receiving medical assistance or members of the TANF benefit group are required to report to PIL when injured by another person or business. Generally, the individual receiving benefits must make a claim against the person, business or insurance that is liable for the injuries.
If an individual is applying for benefits indicates that they are currently being treated for an injury, the injury must be reported to PIL if the individual is approved for Medicaid. The individual can report the injury by clicking the ‘Report Injury” button at the top of this page. If the claim was settled prior to applying for benefits, the individual does not have to report the injury.
If help is needed to complete the web form, contact PIL, a DHS/OHA caseworker or ONE Customer Service (1-800-699-9075).
PIL accepts reports for accident or incident related injuries from clients (or their representatives), DHS/OHA staff, attorneys, insurance adjusters and Coordinated Care Organizations.
Frequently Asked Questions
If you are uncertain about Medicaid coverage, you can call the OHP Call Center at 1-800-699-9075 to confirm your coverage.
No. A CCO is not insurance or subject to Oregon insurance law. It is an organization that contracts with the state to administer Oregon Medicaid (medical benefits).
You can call your local DHS office or ask your caseworker.
Personal injuries that occur as the result of an accident or incident should be reported at www.reportinjuries.org
. Anyone can report so if the client is unable to report, their authorized representative or caseworker can report for them. If alternate format is needed, call PIL for assistance.
Clients receiving Medicaid or TANF benefits are required to report injuries. If the client is unable to report, their representative (which could be a parent or another person) may report for them.
Federal law states that to receive Medicaid benefits you must report injuries and cooperate with PIL. State law requires that the state recover payments that were made by the state when another entity was legally liable to pay. When a client fails to cooperate, they are at risk of losing their Medicaid benefits.
For non-Medicaid benefits, state law also requires you to make a report.
If you fail to report an injury in a timely fashion, you might be personally liable for the money that the state would have been able to collect from the liable person or business.
The coverage under your motor vehicle insurance may run out. If it does the state may pay claims for health services that are covered by Medicaid. Timely reporting is important because it’s the law to report and so the state can protect its rights to be reimbursed from the liable party.
If any claims from the injury have been settled before you apply then you do not have to report the injury. However, if the injury claim is not settled, or you are still receiving treatment for the injury, the state is required to determine whether any benefits paid by the state are payable by the liable person or business.
The caseworker may submit the online form for you. You will want to confirm with the caseworker if they are going to do this for you. Remember that failure to cooperate could result in loss of future benefits and personal financial liability to the state. After the web form is submitted, PIL may still need additional information and may contact the submitter. To prevent potential issues, it is important the injury be reported.
Any attorney that is practicing law in Oregon must comply with the state law that requires the attorney to report the injury of a client that is receiving benefits from Oregon. If the attorney does not report the injury, the client is required to report. Clients should confirm if their attorney reported the injury.
No. State law requires the Attorney General to represent the state and any agency of the state.
Yes, the CCO and PIL must be notified of an injury. They may have each paid a claim for medical benefits. A lien placed by PIL has priority over a CCO lien.
The responsible party is any person, including but not limited to, a businesses or government entity that may be legally liable for some or all of the medical expenses related to the injury or accident.
They might be. Most motor vehicle insurance policies contain Personal Injury Protection (PIP) coverage that would be required to pay any medical expenses before Medicaid. Also, your Uninsured Motorist or Underinsured Motorist Coverage may be liable to pay for some or all of the expenses of your injury. Depending on the circumstances of the case, the state may seek reimbursement from them.
We recommend that you contact your insurance company, but generally speaking,
claims against Personal Injury Protection do not result in a premium increase. Claims against your Uninsured Motorist or Underinsured Motorist coverages may result in a premium increase if you are determined to be partially at fault. We recommend checking with your insurance company to be sure.