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Tort and Casualty

The Tort and Casualty Unit in the Benefits Coordination section of the Department recovers money from a legally responsible third party when the Department has paid claims on behalf of a Medicaid client.  These circumstances commonly include payments, awards, or settlements from auto, homeowners' and malpractice insurance carriers intended to compensate the clients for their injuries.  Medicaid has an automatic lien by statute in these circumstances.  We are required by state and federal law to take all reasonable measures to identify parties and to seek reimbursement from those legally responsible parties.

By law, you or your representative must provide the Department written notice within fifteen (15) days after the filing of an action or claim against a third party.   Section 25.5-4-301(6), C.R.S.

 

Medicaid clients

To report an incident or accident, submit a form or letter which includes the following information:

  • Injured party's name
  • Medicaid ID or Social Security Number
  • Date of birth
  • Date of incident or accident
  • Type of incident or accident
  • Nature of the injuries
  • Contact information of the insurance company and claim number
  • Contact information for your attorney

Attorneys

To notify the Department of a claim on behalf of a Medicaid client, the Department must also receive:

  • A Letter of Representation
-Injured party's name
-Medicaid ID or Social Security Number (Clients call 1-800-221-3943 for ID#)
-Date of birth
-Date of incident or accident
-Type of incident or accident
-Nature of the injuries
 

Insurance company representatives

When providing notice of a Medicaid client's claim, include the information described above for clients on company letterhead.

 

Mail or Fax to:

Colorado Department of Health Care Policy and Financing
Attention: Benefits Coordination Department
1570 Grant Street
Denver, CO 80203
Fax number: 303-866-3552
                                                                                                                         

Note:  Under Colorado State Law, failure to comply with providing notice of an action within fifteen (15) days or failure by a party to a judgment award or settlement to satisfy Medicaid's lien shall make the recipient, legal guardian, executor, adminstrator, attorney, or other representative liable for the entire amount of medical assistance furnished to or on behalf of the recipient for the injuries that gave rise to the action or claim.  Sections 25.5-4-301(5) & (6), C.R.S.

 

Click here for more information:  Tort and Casualty Presentation

Or contact:   

Deborah Sorenson
Phone: 303-866-3109
Fax: 303-866-3552