In a personal injury case, a medical lien is where a health care provider gives treatment at a discounted price or without charging upfront at all, but then has a right to get paid for the medical bills directly from the settlement or judgment. This allows you to receive medical services “on credit” to be repaid once the case is resolved.
Here are five things to know about medical liens in California personal injury cases:
- Providers typically grant a medical lien when you have been in an accident and you do not have healthcare insurance or are otherwise unable to afford medical care.
- Since personal injury cases are not always successful, not every doctor, chiropractor, and therapist is willing to work on a medical “lien basis” in California.
- Lien agreements are negotiable binding contracts, and you should have an attorney review the lien before you sign.
- Medical liens should be avoided unless you have no other way of getting healthcare.
- If you lose your case or do not recover enough money to pay back the doctor, the doctor can exercise the lien against you.
To help you better understand when you should use a medical lien in a California injury or accident case, our California personal injury lawyers discuss below:
- 1. How do I find a doctor willing to accept a lien in California?
- 2. How does a medical lien work in California?
- 3. Are agreements with doctors negotiable?
- 4. Is it a good idea to hire a doctor on a lien basis in California?
- 5. Won’t high medical bills get me a better settlement?
- 6. What happens if I lose my case?
- 7. What is the statute of limitation for a medical lien in California?
- 8. Why should I hire a lawyer to negotiate my lien agreement?
Not all healthcare providers are willing to give you medical treatment pursuant to a lien. A provider who accepts a lien is extending you credit for medical costs.
Like all parties that provide goods and services on credit, the provider needs to know they will be paid back.
Most providers who work on a lien basis will only do so if they think the case is winnable. Since the provider is an expert in medicine, not law, it helps to have a referral from a lawyer the provider trusts.
The lawyer can reassure the provider that your injury was the result of someone else’s
After a doctor or other medical provider agrees to treat you on a lien basis for medical expenses, the provider will have you sign a lien agreement.
The lien agreement is a legally binding contract. Once the contract has been signed, the doctor will “perfect” the lien by sending a notice to
- the responsible insurer and
- other interested parties.
Perfecting the lien allows the other party or its insurer to pay the doctor directly from a court award or out-of-court settlement before you receive settlement money.2
There are also “statutory medical liens.” Under California law, hospitals are allowed to place medical liens against the at-fault parties so that you can receive emergency care services.
For hospitals to place statutory medical liens, they have to give written notice of the charges to the at-fault party. Then once you get compensated for your medical expenses, the hospital has one year to recover their costs.
When Medi-Cal (California’s Medicaid program) places statutory liens, it will receive a part of your ultimate judgment or settlement. The California Department of Health Care Services (DHCS) can even
- sue the at-fault parties on your behalf,
- intervene in your lawsuit against the defendant, and
- assert its lien on your monetary recovery.3
Learn more about the DHCS Personal Injury Program.
Yes. Lien agreements with doctors and other healthcare providers are negotiable in California.2 For example, you can negotiate on
- the method of payment,
- how to calculate payment depending on your settlement or judgment,
- what happens if you do not get a settlement or judgment, and
- how to resolve disagreements.
Many doctors will not negotiate their lien rights documents because they
- do not understand them and
- do not want to pay to have their lawyer review requested changes.
However, the lien agreement is a legally binding contract. If the agreement is particularly one-sided and the provider will not change it, it may be worth your time and effort to find another provider.4
As a general rule under state law, you should use a medical lien only
- when there is no other way to get treatment or
- when you are uninsured or cannot afford your deductibles and co-pays.
One significant advantage to medical insurance is that in-network providers cannot charge the insured more than the providers have agreed under their contract with the insurance company.
If you have a favorable plan, these pre-negotiated payments will often be lower than the amounts you would owe under a lien.
It is a common misconception that an insurer will “punish” you if you pay less than the full amount for medical care after an accident.
Though doctors bill initially at their full rates. It is these bills that get sent to the other side. Settlement offers and awards are based on the value of the doctor’s services, not the amount you pay.
Since you are ultimately liable to pay for services received, it only makes sense to have that be at the lowest rate possible.
If you agreed to a lien and then lose the case or do not recover enough to pay your medical bills, you are liable for the remainder.
The provider will then have all remedies available under
- California law and/or
- the terms of the lien agreement
to collect on the debt.5
However, an experienced California injury lawyer can often negotiate a reduction of the lien amount on your behalf – even if the lawyer did not negotiate the lien agreement.
Most medical professionals would prefer to work out a payment plan than to have to take you to court or arbitration.
We are often able to negotiate a reduction so that the doctor is happy but you still has something left over as compensation for pain and suffering.
The statute of limitations for enforcing a medical lien in California is four years. This means medical providers have four years from the date the lien agreement was signed to take legal action if you do not pay the lien. After four years pass, the medical lien expires, and the provider loses the right to pursue payment through the courts.
However, this statute of limitations only applies to the provider’s ability to enforce the lien in court. You may still technically owe the underlying medical debt beyond four years, but the provider loses the special lien rights for direct repayment from settlement funds after the statute of limitations passes.6
Note that many lien agreements specify that you are holding any settlement money in trust for the medical provider if you do not pay. In these cases, there is no statute of limitations, and you can be sued at any time.
Related statutes of limitations
In cases of statutory liens, hospitals have only one year to seek payment.7
Meanwhile, Medi-Cal has three years to sue the at-fault third party.8
Finally, the standard statute of limitations to file suit in California personal injury cases is two years after the accident (or after you discovered the injury).9
A contractual medical lien is legally binding. Among the rights it typically grants the provider are:
- The right to be paid before anyone else once you are awarded a judgment or settlement;
- The right to recover any excess amounts directly from you; and
- The right to have all disputes resolved by arbitration rather than a jury.
Standard lien agreements are drafted so as to favor the doctor or provider – sometimes significantly.
Having a lawyer negotiate – or even better, draft – the lien agreement can result in much more favorable terms.
For instance, a lawyer may be able to negotiate a discount in the event
- you lose the case or
- the settlement is not enough to cover the medical bills.
- California Code of Civil Procedure section 3040. See, for example, Moore v. Mercer (. , 2016)
- See same.
- See California Civil Code section 3045.3; also see County of San Bernardino v. Calderon (2007) 148 Cal.App.4th 1103; Kizer v. Ortiz (. When Medicare is used to pay for medical services, the government automatically has a lien for reimbursement from the proceeds of a personal injury lawsuit or out-of-court settlement. 42 U.S.C. 1395y(b)(2).
- See note 1.
- California Code of Civil Procedure 337.
- California Code of Civil Procedure 3045.5.
- California Code of Civil Procedure 338.
- California Code of Civil Procedure 335.1.