Medical Treatment Liens: When You Can't Afford the Treatment You Need


Yeah, the medical bills are, ahem, steep.

It's no secret that medical care is really, really expensive. After all, it's not every day that a major industry (healthcare) jacks its prices up so much that it literally breaks another major industry (health insurance) and forces the federal government to step in. This major expense is often highly problematic for injured people who don't have health insurance (or who have a policy with a massive deductible). Let's look at an example to illustrate just how unpleasant these scenarios can get.

Olga was injured in a car accident and suffered a herniated disc in her back. She's in excruciating pain and she can't sleep, drive, or work because it hurts too badly. She needs medical care urgently, but she doesn't have health insurance and can't afford to pay the bills out of pocket. Every provider she talks to, seeing that she doesn't have insurance, refuses to treat her without payment up front. Olga ends up self-medicating with aspirin, and a lot of it.

Six months later, Olga's still in pain and still self-medicating. She files a personal injury claim with the liability coverage of the person who hit her, and because there aren't any medical bills or records to support her claimed injuries, the adjuster denies everything outright. He says that the denial is based on the fact that there isn't any evidence of injury, and that if Olga was really hurt that badly, she would have gotten treatment regardless of what the expense was. 

Now, is this logic flawed? Yes. Is it unfair? Yes. Does it happen all the time? Absolutely. You can bet that adjusters will almost always deny claims that aren't accompanied by proper medical care, regardless of the reason. If Olga took her case to court, you can also bet that the jury would have reached the same conclusion that the adjuster did. Judgment for the defendant, Olga takes nothing.

Now, before we move on, I want to make something abundantly clear to anybody reading this. I'm not telling you that treatment is paramount because it's the only way to get money from a personal injury claim. I'm telling you that your treatment is paramount because your health is paramount. If you've been injured, your number one priority absolutely must be getting back to a hundred percent or as close to it as you can (what doctors call your "maximum medical improvement"). For that reason alone, it's crucial that you go and get treatment for your injuries. If the expense is prohibitive for you, then keep reading. You may have options.

Treating on a lien.

A few months ago, we waxed eloquent about medical liens under North Carolina General Statutes §§ 44-49 and -50. That two-part article, located here and here, explained (and I'm paraphrasing here) that medical providers who are owed money for services rendered can claim a lien against your recovery if they (i) provide notice of the lien, (ii) provide medical bills for free, and (iii) provide medical records for free. 

If you're reading carefully, you probably notice the tremendous up-side that these statutes carry. Basically, § 44-49 liens allow medical providers to treat you today and secure payment for that treatment once you settle your personal injury claim. This is huge news for injured people who can't afford to pay out-of-pocket for their treatment, and it makes the process more manageable for pretty much everybody involved. However, there are several things that you need to watch out for before you go and ask the doctor to treat you on a lien.

The pitfalls.

  1. Providers aren't required to agree to lien-basis treatment. Mostly the providers that agree to this are primary care physicians, chiropractors, physical therapists, and the like. Neurologists, orthopedists, and more specialized providers will often balk unless they're highly familiar with you, your case, and often your attorney as well. Just be aware that you can't waltz in and gleefully announce that you're treating on a § 44-49 lien. You can ask, but they don't have to say yes.
  2. If the case falls through, you're still on the hook for payment. Lien treatment doesn't operate the way your attorney's contingent fee agreement does. With your attorney, if you recover nothing, you owe nothing under your standard contingent agreement. With your medical provider, you owe the balance regardless of whether you recover or not. If you rack up a $3,500 chiro bill and then the claim gets denied because the adjuster found your base jumping pictures on Facebook, you're on the hook for that bill. Be warned!
  3. Don't ignore your bills! It's common that folks will get in a wreck and ride to the Emergency Room in an ambulance. When the bills come from the ER and EMS, the injured party just ignores the bills because he or she figures that the liability carrier will take care of them when the time comes. That, ladies and gentlemen, is how you damage your credit score. Go ahead and pay the bills out of pocket if you can, and get reimbursed later when your case settles. If you can't pay out of pocket, call the billing office, explain the situation, and ask to set up a payment plan. The liability carrier generally is not responsible if you mess up your own credit rating.

I hope you find this information helpful; remember that your health is more important than your recovery. If you're injured, you absolutely have to go and get treatment. If you have questions, call me and ask. Good luck in 2018!