PM 23-07-01.

  1. (FCRC) Check Form 2378H, Request for Medical Assistance - Hospital/Nursing Home Application, to see if there may be a personal injury claim.
  2. (FCRC) Notify the Bureau of Collections, if a client has been injured in a way that may have a personal injury claim.
    1.  Report an injury to a GA client who has a dependent receiving TANF or AABD.
  3. (FCRC) Complete Form 44, Report of Personal Injury.
    1. Show in Item 17 the act or law that the claim is based on, such as Worker's Compensation or Crime Victim's Compensation.
  4. (FCRC) Distribute Form 44:
    • original to FRC, and
    • copy in the case record.
  5. (FRC) Send original Form 44 to BOC.

    Outside Cook County:

    Technical Recovery Section
    2200 Churchill Dr. Bldg. A
    Springfield, IL 62702-3406

    In Cook County:

    Technical Recovery Section
    401 S. Clinton Ave., 5th Floor

    Chicago, IL 60607-3800

  6. (FCRC) Suggest that the client contact a lawyer if they know who caused the injury.
    1. Give the client information about contacting the local bar association or lawyer referral service if they do not already have a lawyer.
  7. (FCRC) Suggest that a client who is a crime victim contact the Court of Claims at:

    188 W. Randolph, Suite 200
    Chicago, IL 60601

    or

    630 S. College Street
    Springfield, IL 62756
    They may be able to receive compensation under the Crime Victims Compensation Act. 

  8. (FCRC) Notify BOC by memo, as soon as possible, if a client starts a claim or lawsuit. Include:
    • title of the complaint,
    • county where the suit was filed,
    • name and address of insurance carrier, if involved, and
    • name and address of attorney.
    1. Obtain 3 copies of the complaint, if possible.
    2. Include copies with memo to BOC, Technical Recovery Section.
  9. (BOC/TRS)  Maintains close contact with the client and their lawyer to know the status of the lawsuit.
    1. Monitors the status of lawsuits.
  10. (BOC/TRS) Prepares a Notice of Claim if the information on HFS 44 shows HFS has a charge upon a claim.
    1. Distributes the Notice of Claim:
      • original to responsible party,
      • copy to client,
      • copy to client's attorney,
      • copy to responsible party's insurer, and
      • copy to Family Community Resource Center.
  11. (BOC/TRS) Sends HFS 2374, Information about Public Aid's Personal Injury Lien, with the Notice of Claim, to:
    • responsible party,
    • responsible party's insurer, and
    • responsible party's attorney.
  12. (BOC/TRS) Sends HFS 2374A, Notice Regarding Lump Sum Payment of Claim for Personal Injuries, with the Notice of Claim. The form tells the client the action HFS will take when a lump sum personal injury payment is received. The HFS 2374A is sent to:
    • client, and
    • client's attorney.

Claim Settlement

When a settlement or pending settlement occurs:

  1. (BOC/TRS) Determines the amount of HFS's charge.
  2. (BOC/TRS) Notifies the client and anyone paying the settlement that HFS must be paid before a release can be completed.
  3. (BOC/TRS) Asks the party paying the settlement to write a separate check to HFS for the amount of HFS's charge.
  4. (BOC/TRS) Completes Form 3021, Payment Transmittal Slip, and check the "Personal Injury" section.
  5. (BOC/TRS) Completes Form 110, Report on Charges for Injury Claim, when there is a settlement. Include the settlement terms with a breakdown of how the money is to be distributed.
    1. Specifies case numbers and periods covered if HFS's charge covers clients in more than one case.
  6. (BOC/TRS) Sends Form 110 to FCRC for the case record.
  7. (LOA)Mark a check received as payment of HFS's claim received at FCRC:
    • "For deposit only, pay to the order of the Treasurer, State of Illinois, Department of Healthcare and Family Services."
      1. Send the check and completed HFS 3021 to

        Bureau of Collections
        Technical Recovery Section
        2200 Churchill Dr. Bldg. A
        Springfield, IL 62702-3406 

  8. (LOA) Contact Field Recovery Unit for instructions if the payor sends a check payable to HFS and another party.