(A) Benefits may be provided under the TAFDC,
EAEDC, or MassHealth programs as a result of an accident, injury, or illness.
When payment is expected to be provided by liability insurance, Workers'
Compensation, or other source, the Department and MassHealth require an
assignment which conveys and transfers to the Department the right to recover
an amount equal to the benefits provided as a result of said accident, injury,
or illness. This assignment is required as a condition of initial and
continuing eligibility at application, eligibility review, or at any time that
the information becomes known to the Department.
The applicant or client is required to notify the Department,
in writing, when a claim for compensation or recovery has begun, and of any
settlement negotiations before they become final. A claim includes, but is not
limited to:
(1) a court action or other
proceeding;
(2) notification to the
applicant's or client's own insurance company; and/or
(3) notification to any third party that may
be liable.
(B) It is the
responsibility of the applicant or client to provide the details of a claim for
any member of the filing unit. The information required includes, but is not
limited to, the following:
(1) name and
address of the applicant or client;
(2) date and place of the accident, injury,
or illness;
(3) type of case
(i.e., industrial accident, personal injury,
etc.);
(4)
explanation of the circumstances surrounding the accident, injury, or illness
and the status of the case;
(5)
name and address of the applicant's or client's attorney;
(6) name and address of all insurance
companies involved including Personal Injury Protection (PIP) carriers, and the
name of the insured individual;
(7)
a copy of the applicant's or client's automobile insurance Coverage Selection
Page (if involved in an automobile accident);
(8) a copy of any other type of insurance
that the applicant or client owns that may be applicable;
(9) a copy of any complaints and/or other
legal documents filed by the applicant or client or on his or her behalf or on
behalf of any member of the filing unit; and
(10) a copy of the police report (if
applicable).
Upon any partial or final settlement of the case, the applicant
or client who signed the original assignment or his or her attorney or
authorized representative (if the applicant or client has one) is required to
provide the Department with information on the amount of the settlement and the
details surrounding it.
Failure to comply with any of these provisions is grounds for
denial, closing, and/or referral to the Bureau of Special
Investigations.
Workers may not compute the amount of a lien, but must make a
referral to the Department's authorized agent for computing the amount of a
lien.
