Or. Admin. R. 461-195-0305 - Lien of the Department, Coordinated Care Organization, or Prepaid Managed Care Health Services Organization

(1) Whenever a recipient (see OAR 461-195-0301) has a claim (see OAR 461-195-0301) for damages for a personal injury (see OAR 461-195-0301), the Department (see OAR 461-195-0301) shall have a lien upon the amount of any judgment (see OAR 461-195-0301) in favor of a recipient or amount payable to the recipient under a settlement (see OAR 461-195-0301) or compromise (see OAR 461-195-0301) as a result of that claim for all assistance (see OAR 461-195-0301) received from the date of the injury to -

(a) The date of satisfaction of the judgment favorable to the recipient; or

(b) The date of the payment under the settlement or compromise.

(2) The person or public body, agency or commission bound by the judgment, settlement, or compromise shall be responsible for immediately informing the Personal Injury Liens Unit (see OAR 461-195-0310 for address) when a judgment has been issued or a settlement or compromise has been reached so that the exact amount of the lien of the Department may be determined. For the purposes of this rule, immediately means within ten calendar days.

(3) The lien does not attach to the amount of any judgment, settlement, or compromise to the extent of the attorney fees, costs and expenses which the recipient incurred in order to obtain that judgment, settlement, or compromise.

(4) The lien does not attach to the amount of any judgment, settlement, or compromise to the extent of medical, surgical and hospital expenses incurred by the recipient on account of the personal injuries for which the recipient had a claim or action (see OAR 461-195-0301). "Incurred" refers only to those medical, surgical and hospital expenses the recipient has paid or is legally obligated to pay at the time of the judgment, settlement, or compromise, excluding any expenses that a third party will reimburse the recipient.

(5) The lien of the Department must be satisfied or specific approval must be given by the Department staff of the Personal Injury Liens Unit before any portion of the claim judgment, settlement, or compromise is released to the recipient. The Department shall have a cause of action against any person, public body, agency, or commission bound by the judgment, settlement, or compromise who releases any portion of the claim judgment, settlement, or compromise to the recipient or the agent of the recipient before meeting this obligation.

(6) This rule applies to any lien assigned by the Department under OAR 461-195-0321.

(7) Notwithstanding any other provision in this rule, there is a rebuttable presumption that the entire proceeds from any judgment, settlement, or compromise are in payment for medical care or services. The presumption may be rebutted only by clear and convincing evidence. This presumption applies to any lien created under ORS 416.540, regardless of whether the lien, judgment, settlement, compromise, or claim occurred before, on, or after October 1, 2017.

Notes

Or. Admin. R. 461-195-0305

AFS 62-1989, f. 10-5-89, cert. ef. 10-15-89; AFS 26-1993, f. 10-29-93, cert. ef. 11-1-93; Renumbered from 461-010-0105; SSP 19-2005, f. 12-30-05, cert. ef. 1-1-06; SSP 15-2006, f. 12-29-06, cert. ef. 1-1-07; SSP 27-2017, temporary amend filed 10/04/2017, effective 10/04/2017 through 03/31/2018; SSP 33-2017, amend filed 12/8/2017, effective 1/1/2018; SSP 19-2018, temporary amend filed 05/04/2018, effective 05/04/2018 through 09/30/2018; SSP 28-2018, amend filed 09/06/2018, effective 10/1/2018

Statutory/Other Authority: ORS 409.050, 411.060, 413.085 & 414.685

Statutes/Other Implemented: ORS 659.830, 743B.470, 409.010, 411.060, 413.085, 414.685, 416.351 & 416.510 - 416.610