Should Health Care Providers Make Medical Liens Part of their Billing Practices?

By Richard H. Adler, Attorney at Law

All licensed health care providers in Washington are permitted to use the lien law to protect their bill from an insurer, attorney or patient that may be unwilling to pay for outstanding services once a personal injury claim is concluded These type of liens are governed by Washington statute and can be found in Revised Code of Washington at 60.44.010 through 60.44.060.

RCW 60.44.010 allows every duly licensed practitioner or physician to put a lien on any claim and/or money to which his/her patient is entitled from any tortfeasor (the responsible party) or his/her insurer. RCW 60.44.010 provides in part:

Every ambulance, hospital, and every duly licensed nurse, practitioner, physician, and surgeon rendering service, or transportation and care, for any person who has received a traumatic injury shall have a lien upon any claim against any tortfeasor and/or insurer of such tortfeasor for the value of such service, together with costs and such reasonable attorney’s fees as the court may allow, incurred in enforcing such lien. RCW 60.44.020 states that the lien is filed with the County Auditor of the county in which the health care services were provided.

The lien need not be filed with anyone else. However, to make a lien more effective (by giving notice to all involved parties), one is best served by mailing a copy of the lien to:

  • The insurance company for the tortfeasor;
  • Patient;
  • Attorney for the patient;
  • The patient’s insurance company.

It may be paying the provider’s final bill under the uninsured or underinsured motorist coverage of the patient’s policy. The law indicates that a lien must be filed within twenty (20) days of the date of injury or receipt of care. However, if the lien is not filed with the auditor’s office within twenty (20) days, one can still file the lien as long as settlement and payment have not been made to the injured party. RCW 60.44.020.

A lien is never discharged unless settlement provides for the payment and discharge of such a lien. The lienholder must then file a written release. RCW 60.44.050 states:

No settlement made by and between the patient and tortfeasor and/or insurer shall discharge the lien against any money due . . . unless such settlement also provides for the payment and discharge of such lien or unless a written release or waiver of any such claim of lien, signed by the claimant, be filed in the court.

Under the provisions of RCW 60.44.060, there is effective recourse to enforce a lien. However, one must enforce the lien within “one year after the filing of such lien against a tortfeasor and/or insurer,” otherwise the lien holder must re-file the lien with the County Auditor in order to keep the lien active and enforceable until it is satisfied.

There is a limitation on the amount that can be claimed in a health care lien. RCW 60.44.010 provides that the combined amount of all providers’ liens shall not exceed twenty-five percent (25%) of the amount of an award, verdict, report, decision, decree, judgment, or settlement. So, for every $10,000.00 of an award or settlement, a properly filed lien will only protect the provider up to $2,500.00. To remedy this limitation you may want to consider having your patient sign a “guarantee” of payment of your bill regardless of the lien law limitations.

The attorneys of Adler Giersch, PS encourage health care providers to establish well-functioning procedures for the filing of statutory medical liens in patient cases where a balance is pending for treatment related to personal injuries.

Just as PIP insurance coverage must pay the providers “reasonable and necessary” charges, a properly filed lien will provide for payment of the provider’s services, provided the liens do not exceed 25% of the total recovery by the patient
If the insurance company for the tortfeasor (the “third party insurer”) receives a copy of the lien, more often than not the third party insurer will take steps to assure the payment of the provider’s lien. However, no matter what agreement there may be between the third party insurer and the attorney and patient for payment of a provider balance, the third party insurer will remain responsible for payment of the lien, assuming there is a valid lien on the claim. Under these circumstances, firm and persistent pressure on the third party insurer progressively up the chain of command will result in payment. A properly filed lien is enforceable, allows for attorney’s fees and costs, and thus third party insurers will ultimately pay. Well-functioning lien filing procedures in the billing departments of treatment providers provide confidence and leverage to the accounts receivable personnel in the collecting of treatment costs.

Finally, the assurance of the payment of provider balances in personal injury matters can rest with the patient’s advocate who has a reputation for ensuring that their client’s healthcare expenses are paid in full at the conclusion of a claim. The attorneys of Adler Giersch, PS have always committed themselves to the principal of the providing its clients with the highest degree of legal representation with integrity and ensuring that their financial obligations to their health care providers are satisfied at the conclusion of their claim.