WORK PRODUCT OF MATTHIESEN, WICKERT & LEHRER, S.C. Page 1 Last Updated 1/13/22
MATTHIESEN, WICKERT & LEHRER, S.C.
Hartford, WI ❖ New Orleans, LA ❖ Orange County, CA
❖ Austin, TX ❖ Jacksonville, FL ❖ Boston, MA
Phone: (800) 637-9176
[email protected]
[email protected]
www.mwl-law.com
HOSPITAL LIEN LAWS IN ALL 50 STATES
The advent, development, and implementation of hospital and health care provider lien laws in the U.S. is a subject which has permeated civil litigation and personal
injury law. Simply put, a hospital or health care provider lien is a statutory lien enacted for the benefit of hospitals or health care providers to assist them with the
recovery of medical expenses associated with emergency medical treatment. Hospitals or other health care providers are generally allowed to perfect this special lien
against any lawsuit, claim, or recovery a patient has against a third-party tortfeasor responsible for causing an injury. Hospital liens are also often referred to as “health
care provider liens” or “medical liens.” For the sake of simplicity, we refer to them generically as “hospital liens.”
Hospital lien laws first began making an appearance during the 1930s in order to protect hospitals from the burden of treating uninsured and/or indigent patients and
to provide a motivation to treat patients requiring emergency medical care even before they verify the existence of health insurance coverage. This original legislative
intent of these lien statutes has gradually eroded—but not entirely disappeared—as the percentage of those covered by health insurance (9.3% in 1940) has grown
exponentially. The most common scenario involving a hospital lien is when a person requires emergency medical treatment as the result of an automobile accident, and
subsequently brings a claim against the responsible driver who caused the accident. Each state has different procedures and requirements for the establishment and
enforcement of these liens. Georgia and Texas, for example, require the lien to be filed in specific courts. California and Louisiana, on the other hand, merely require
that the lien be served on the interested parties by certified mail.
The Texas Hospital and Emergency Medical Services Lien statute (Tex. Prop. Code §§ 55.001 to 55.008), for example, requires a lien to be filed in the county where the
hospital is located, but is still applicable to recoveries made in other counties, even if suit is not filed. The lien only applies if the patient is admitted to a hospital or if
emergency medical services are provided within 72 hours of the accident. If the patient is transferred to another hospital, that hospital may also file a lien if the first
hospital had the right to do so. The lien must state the name and address of the injured person and the date of the accident. It must also state the name and address of
the hospital as well as the name of the at-fault party (if known). Once the lien is filed, the hospital must mail notice of the lien to the injured person or their legal
representative. Once a hospital secures a valid lien, the hospital’s right to recovery is superior to the patient’s right of recovery. If transported by ambulance, an
emergency medical services provider (EMS) can also assert a lien, but only in a county of 800,000 or less. The lien does not attach to uninsured/underinsured motorist
benefits, Med Pay or PIP benefits, or workers’ compensation benefits. The amount of the lien is the lesser of (1) the amount of the hospital’s charges during the first 100
days, or (2) 50% of all amounts recovered by the patient through a cause of action, judgment, or settlement. It also includes a doctor’s reasonable charges during the
first seven (7) days. Every state is different. Some states liberally enforce these laws so that technical deficiencies in establishing or seeking enforcement do not defeat
recovery by the hospital. Other states are less likely to ignore such deficiencies.
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Perfecting Hospital Liens
States differ on their procedures, but a hospital lien is generally perfected by filing with the county clerk, the district court, or other government body specified in the
hospital lien statute, written notice of the name and address of the patient, the third-party tortfeasor (if know), the liability carrier (if known), the name and address of
the hospital, and the amount of the lien. Once a notice of hospital lien is filed in the county where the hospital is located, the district court/clerk is usually required to
maintain a hospital lien docket that can easily be searched, and in which any hospital lien claim filed is entered. The district court usually lists the name of the injured
person, the name of the person, firm, or corporation alleged to be liable for the injuries and damages, the date and place of the accident, and the name of the hospital
or other institution making the claim. The district court also often maintains an index of the hospital lien docket under the name of the injured person. Hospitals are
often then required to send, by certified mail or other means, written notice of the lien filing to the patient, the third-party tortfeasor, and/or the liability carrier.
Hospital liens vary widely from state to state. These variations include such things as whether or not the lien applies to workers’ compensation claims and/or wrongful
death claims. Some states (e.g., Tennessee) limit the percentage of the total settlement that can be recovered under a hospital lien when the patient is not “made whole”
by the third-party settlement. Other states (e.g., New York and Alabama) require that the treatment occur within a certain time frame in relation to the accident which
caused the injury in order for the lien to be able to apply to medical expenses incurred as a result. In other states, if an attorney requests a copy of a client’s bill and/or
medical records, that documentation must be provided free of charge to the attorney, possibly within a limited period of time, or the lien is not valid.
The hospital lien laws of thirty-two (32) states provide that an attorney’s lien/fee takes precedent over the hospital lien. These include AL, AK, AZ, AR,GA, ID, IN, IA, KS,
LA, ME, MD, MA, MN, MO, MT, NE, NV, NM, NY, NC, OK, OR, RI, SD, TN, TX, UT, VT, VA, WI, and the District of Columbia. Six (6) states’ statutes provide that the hospital
lien takes precedence over all other liens (CA, CO, DE, CT, NJ, NH). Other states, like Vermont, provide that the hospital lien cannot take more than two-thirds (2/3) of
the total third-party settlement or $500, whichever is higher, after attorneys’ fees. Twenty-four (24) states have legislated that hospital liens cannot be recovered from
workers’ compensation settlements. Yet other states (e.g., New Jersey) subordinate a physician’s or dentist’s lien cannot claim more than 25% of the third-party recovery
remaining after a hospital lien has been repaid.
The amount asserted in a hospital lien has also become a point of contention across the country and varies from state to state. While the law in every jurisdiction allowed
plaintiffs in personal injury lawsuits to recover the “reasonable value” of the medical services incurred, defendants have begun to argue that such medical expenses are
neither “reasonable” nor “incurred” by the plaintiff because they were paid by a collateral source (e.g., private health insurance, state Medicaid, Medicare, workers’
compensation, governmental assistance programs, etc.). A “collateral source” is benefits received by the plaintiff from a source wholly independent of any collateral to
the wrongdoer. The defendants argue that the medical bills are not “reasonable” because they were reduced or written off by the insurance provider, who accepted
insurance payments; thus, defendants argue that the injured plaintiff’s reasonable medical expenses and damages should be limited to sums “actually paid” by the
insurer and proof of the full medical charges that were billed (either written-off or paid by insurance) should be excluded. Proving the reasonable value of medical
services has become both controversial and confusing; and every state has gone its own way in dealing with the issue. For a chart covering the subject of the amount of
medical expenses that can be introduced into evidence and/or recovered in personal injury civil litigation—amount charged, amount paid by the patient or a collateral
source (such as workers’ compensation or health insurance), or some other amount—in all 50 states, see HERE.
Another growing area of controversy is the utilization of hospital lien filings even before the medical expenses are presented to the patient’s commercial health insurance
company/plan. The purpose of this is that it can assert a lien for the full “retail” reasonable and necessary medical expenses, as opposed to the discounted amount it is
limited in recovering from the health insurance company/plan. Some claimed hospitals were “gaming the system” by lying in wait and relying on hospital liens, because
they netted a higher reimbursement than submitting them to the health insurance company/plan. In other words, some claimed that hospitals were using the hospital
lien system—originally intended to make sure hospitals got paid after treating uninsured accident victims—as a sword, rather than a shield.
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Assignment of Benefits
Doctors, hospitals, and other health care providers often requires patients to execute an “Assignment of Benefits” (AOB) agreement as part of the paperwork that is
signed when a patient is first admitted to a hospital or otherwise treated. An AOB is an agreement that, once signed, transfers the insurance claims rights and benefits
of the policy from the member (that’s you) to a third party (e.g., a hospital). An AOB gives that third party the authority to file a claim, collect insurance payments, pursue
third-party tortfeasors, and even file lawsuits without the involvement or awareness of the policyholder and patient. In some cases, a hospital might not file on the
patient’s health insurance and instead assert a lien on the patient’s personal injury settlement. AOB agreements are somewhat controversial but are essential to a
hospital’s or health care provider’s practice. They help ensure that the provider has a right to payment from the patient’s health insurer. An AOB authorizes a health
insurance company/plan or its third-party administrator to make payments directly to the treating medical provider. Essentially, the patient is “assigning” their right to
receive payment for medical benefits under the health insurance policy or plan. In many states, there is a distinction between the assignment of a claim for personal
injury and the assignment of the proceeds of such a claim. The assignment of a claim gives the assignee control of the claim and promotes champerty. Such a contract is
against public policy and void in some states. The assignment of the proceeds of a claim does not give the assignee control of the case and is valid in many states. There
are limitations on such contracts, however. For example, in North Carolina, an assignment of benefits contract stands on equal footing with a medical lien, and the
provider cannot recover more under the contract than it could under the medical lien statutes. Smith v. State Farm Mut. Auto. Ins. Co., 358 N.C. 725 (N.C. 2004).
Statewide Uniform Lien Laws
Forty-two (42) states have statewide uniform lien laws covering the entire state. Florida, Kentucky, Michigan, Mississippi (repealed in 1989), Ohio, Pennsylvania, South
Carolina, West Virginia, and Wyoming are the only states without statewide lien law provisions. These states do not currently have a statute with a general “medical
lien” provision that establishes a statutory foundation for all health care providers and institutions to file liens in the state. For example, Florida does not have a
comprehensive state hospital lien statute. Florida grants the autonomy to enact hospital lien statutes to the individual counties within the State of Florida. Some Florida
counties allow liens for non-profit hospitals, while others allow them for all hospitals.
In certain states, such as Delaware and Wisconsin, the hospital lien statute only applies to charitable hospitals.
Most states have enacted their own statutes or “Acts” relative to hospital liens. For example, in 2003, in an effort to organize a variety of state lien laws, Illinois enacted
the Health Care Services Lien Act (HCSLA). It consolidated the following pre-existing statutes:
(1) Hospital Lien Act 770 I.L.C.S. § 35;
(2) Physician’s Lien Act 770 I.L.C.S. § 80;
(3) Emergency Medical Services Lien Act 770 I.L.C.S. § 22;
(4) Physical Therapist Lien Act 770 I.L.C.S. § 75;
(5) Home Health Agency Lien Act 770 I.L.C.S. § 25;
(6) Dentists’ Lien Act 770 I.L.C.S. § 20;
(7) Optometrist Lien Act 770 I.L.C.S. § 72; and
(8) Clinical Psychologist’s Lien Act 770 I.L.C.S. § 10.
The Illinois Act provides for two classes of liens, one for “healthcare professionals” and one for “healthcare providers.” The Act applies to the rendering of health services,
except those made under the Workers’ Compensation Act or the Occupational Disease Act. The Act requires the injured person to give notice to any party holding a lien.
The HCSLA (§ 23/10(c)) limits the total amount of all liens of health care providers to 40% of the damages paid to the plaintiff. 770 I.L.C.S. § 23/10(a). The lienholder has
to provide notice to the plaintiff and defendant in a third-party action and the Act provides that the recovery for multiple liens in the same class (professionals or
providers) must be proportionate such that neither class receives more than one-third (1/3) of the total recovery. 770 I.L.C.S. § 23/10(c). When the total amount of liens
is equal to or greater than 40% of the complete recovery:
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(1) All liens of health care professionals may not exceed 20% of the settlement or verdict; and
(2) All liens of health care providers may not exceed 20% of the settlement or verdict.
The practical effect of the Illinois Act was that if the total of all medical liens were reduced to 40% of the verdict or settlement, and the attorney’s lien was reduced to
30%, there would still be money available to go to the injured party.
About the only uniformities we find throughout the states with dedicated hospital lien laws is that a hospital will have one (1) year in which liability will attach to any
party who has been given proper notice of the lien, and that generally the hospital liens will not attach to any workers’ compensation benefits owed to an injured party.
The following is a chart providing a summary of the hospital lien laws in all 50 states. It is a summary only and a more in-depth review of a state’s particular lien laws
should be undertaken by contacting an attorney. For more information on hospital lien laws and their enforcement, contact Gary Wickert at gwickert@mwl-law.com or
Mark Solomon at msol[email protected].
STATE
STATUTE
COMMENTS
ALABAMA
Alabama Property Code
§§ 35-11-370 – 375.
Lien Declared.
The hospital’s lien attaches to all reasonable charges for
hospital care, treatment, and maintenance of an injured person
who entered such hospital within one week of sustaining
injuries. § 35-11-370.
The lien attaches to all judgments, settlements, and settlement
agreements entered into by the injured party for the actions
related to the injuries for which treatment was sought. § 35-11-
372.
The lien does not attach to any real or personal property of the
injured party.
The lien does not attach to any workers’ compensation
benefits.
The hospital has no independent right to assert a cause of
action against any potential responsible party.
If injured party settles their claim within the 10-day period the
hospital has to perfect the lien, the lien is not waived unless the
hospital signs a release of their lien. If the hospital does not sign
off on the lien during the 10-day period, the hospital is entitled
to bring a civil action for damages and is entitled to seek
recovery of court costs and attorneys’ fees. § 35-11-372.
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STATE
STATUTE
COMMENTS
ALASKA
Alaska St. Art. §§
34.35.450 – 482
Hospital, Physician, and
Nurse Liens.
§ 34.35.465 gives a specific form that must be utilized.
Treatment must have occurred within 20 days of the date of the
injury. § 34.35.455.
Costs and attorneys’ fees are recoverable for the enforcement
of the lien. § 34.35.480.
If the injured party’s claim is resolved, the hospital has only 180
days to bring its cause of action against the injured party or
their insurer. § 34.35.475.
ARIZONA
Arizona Revised Statutes
§§ 33-931 – 936
Health Care Provider
Liens.
A hospital or ambulance service lien that is not recorded within
the time prescribed in § 33-932(A) is still effective against any
settlement or judgment if the lien is recorded 30 days before
the settlement is agreed to or the judgment is paid unless the
lien is recorded in a county where liens are accessible on the
internet. In those counties, if the lien is not recorded or
accessible on the internet at least 30 days before the
settlement is agreed to or the judgment is paid, the lien may
not be enforced. § 33-932(D).
The recording of a lien by a hospital serves as notice to all
parties who may be liable, whether or not they are named in
the lien. § 33-932(C).
The lien does not attach to any workers’ compensation
benefits. § 33-935.
A release of claims on which an assignment or lien is given is
not valid or effective unless the lienholder executes a release of
that lien. § 33-934.
Once a lien has been satisfied, the lienholder must issue a
release of lien or be subject to liability of $100 plus actual
damages. § 33-936.
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STATE
STATUTE
COMMENTS
ARKANSAS
A.C.A. §§ 18-46-101 –
117.
Medical, Nursing,
Hospital, and Ambulance
Service Lien Act.
If after 180 days following the most recent notice of lien, the
lien remains unsatisfied and no suit has been filed by the
provider, the lien becomes invalid. § 18-46-106.
A tortfeasor may not settle the third-party claim within 60 days
of receiving notice of the lien, nor at any time after the lien has
been recorded, unless the lien has been paid to the provider or
has received written notice of a release of the lien. § 18-46-112.
When a lien has been satisfied, a provider must give written
release following a written demand. § 18-46-114.
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STATE
STATUTE
COMMENTS
CALIFORNIA
California Civil Code §§
3045.1 – 6.
Hospital Liens.
The lien applies regardless of whether the damages are
recovered by judgment, settlement, or compromise. § 3045.2.
The hospital has one year from the date of payment to the
injured party to enforce its lien by filing a lawsuit against any
party who was given notice of the lien. § 3045.5.
COLORADO
Colorado Revised
Statutes §§ 38-27-101 –
106.
Hospital Liens.
A lien is not created until a hospital complies with the
requirements of § 37-27-101. § 37-27-101(4).
The filing of the lien must occur prior to any judgment,
settlement, or compromise of the underlying claim. § 37-27-
102.
CONNECTICUT
C.G.S.A. § 49-73.
Liens on Accident and
Liability Policies in Favor
of Hospitals and
Ambulance Services.
There is no mention in the statute about serving notice on the
tortfeasor directly.
The lien does not attach to any workers’ compensation
benefits. § 49-73 (a).
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STATE
STATUTE
COMMENTS
DELAWARE
Delaware Code Title 25
§§ 4301 – 4306.
Hospital Liens.
Hospital liens only apply to charitable hospitals. § 4301.
The lien will attach to any verdict, report, decision, decree,
award, judgment, or final order made or rendered in any action
in any court of record in Delaware. § 4303.
Notice must be sent prior to the payment of any money from
the responsible party to the injured party. § 4302.
DISTRICT OF
COLUMBIA
DC Code §§ 40-201 – 205.
Hospital Liens.
The lien does not attach to any workers’ compensation
benefits. § 40-201.
FLORIDA
No overlying state statute
in Florida.
Hospital liens laws are enacted on a county-by-county basis in
Florida. Not every county has a standing hospital lien law. Given
that there are 67 counties in Florida, the list is too extensive to
include on this chart.
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STATE
STATUTE
COMMENTS
GEORGIA
Georgia Code §§ 44-14-
470 – 477.
Hospitals and Nursing
Homes.
The filing of claim or lien shall be notice thereof to all persons,
firms, or corporations liable for damages, whether or not they
received written notice provided for in this Code section.
Failure to perfect such lien by timely complying with notice and
filing provisions of paragraphs (1) and (2) of subsection (a) of
this Code section shall invalidate such lien, except as to any
person, firm, or corporation liable for damages, which receives
prior to date of any release, covenant not to bring action, or
settlement, actual notice of a notice and filed statement made
under subsection (a) of this Code section, via hand delivery,
certified mail, return receipt requested, or statutory overnight
delivery with confirmation of receipt. § 44-14-471(b).
No release of the cause of action or of any judgment shall affect
the lien unless the lienholder releases the lien. § 44-14-473.
The lien does not attach to any workers’ compensation
benefits. § 44-14-474.
HAWAII
Haw. Rev. Stat. § 507-4.
Dentists, Doctors,
Hospitals.
A judgment debtor may choose to pay the amount of the
judgment to the chief clerk of the Court in which the judgment
is rendered, and thereby be release from any further obligation
to the lien holder. §507-4.
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STATE
STATUTE
COMMENTS
IDAHO
Idaho Stat. §§ 45-701 –
705.
Hospital and Nursing Care
Liens.
The filing of such claim or lien shall be notice thereof to all
persons, firms, or corporations liable for such damages,
whether or not they are named in such claim or lien. § 45-701.
No release of the cause of action or of any judgment shall affect
the lien unless the lienholder releases the lien. § 45-704.
The lien does not attach to any workers’ compensation
benefits. § 45-705.
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STATE
STATUTE
COMMENTS
ILLINOIS
Illinois Statute Chapter
770 §§ 23/1 – 23/999.
Health Care Services Lien
Act.
The total amount of all liens under this Act shall not exceed 40%
of verdict, judgment, award, settlement, or compromise
secured by or on behalf of the injured person on his or her claim
or right of action. 770 § 23/10 (a).
If total amount of all liens under this Act meets or exceeds 40%
of verdict, judgment, award, settlement, or compromise, then:
(1) all liens of health care professionals shall not exceed 20% of
verdict, judgment, award, settlement, or compromise;  and (2)
all liens of health care providers shall not exceed 20% of verdict,
judgment, award, settlement, or compromise; provided that
health care services liens shall be satisfied to the extent
possible for all health care professionals and health care
providers by reallocating the amount unused within the
aggregate total limitation of 40% for all health care services
liens under this Act;  and provided further that the amounts of
liens under paragraphs (1) and (2) are subject to the one-third
limitation under this subsection. 770 § 23/10 (c).
Notice of judgment or award. A judgment, award, settlement,
or compromise secured by or on behalf of an injured person
may not be satisfied without the injured person or their
authorized representative first giving notice of judgment,
award, settlement, or compromise to the health care
professional or health care provider that rendered a service in
treatment, care, or maintenance of injured person and that has
served a lien notice pursuant to subsection (b) of § 10. The
notice shall be in writing and served upon the lienholder or, in
the case of a lienholder operated entirely by a unit of local
government, upon the individual or entity authorized to receive
service under § 2-211 of the Code of Civil Procedure. 770 §
23/15.
Items to which lien attaches. The lien of a health care
professional or health care provider under this Act shall, from
and after time of service of lien notice, attach to any verdict,
judgment, award, settlement, or compromise secured by or on
behalf of injured person. If verdict, judgment, award,
settlement, or compromise is to be paid overtime by means of
annuity or otherwise, any lien under this Act shall be satisfied
by party obligated to compensate injured person to fullest
extent permitted by § 10 before establishment of annuity or
other extended payment mechanism. 770 § 23/20.
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STATE
STATUTE
COMMENTS
INDIANA
I.C. §§ 32-33-4-1 – 8.
Hospital Liens.
The lien does not attach to any workers’ compensation
benefits. § 32-33-4-1.
A lien perfected under § 4 of this chapter is valid unless the
lienholder executes a release of the lien under § 7 of this
chapter. § 32-33-4-6.
The release or settlement of a claim with a patient by a person
claimed to be liable for the damages incurred by the patient: (1)
after a lien has been perfected under § 4 of this chapter;  and
(2) without obtaining a release of the lien; entitles the
lienholder to damages for the reasonable cost of the hospital
care, treatment, and maintenance. § 32-33-4-6.
Satisfaction of a judgment rendered in favor of the lienholder
under subsection (b) is satisfaction of the lien. An action by the
lienholder must be brought in the court having jurisdiction of
the amount of the lienholder’s claim and may be brought and
maintained in the county of residence of the lienholder. § 32-
33-4-6.
A person desiring to contest a lien or the reasonableness of the
charges claimed by the hospital may do so by filing a motion to
quash or reduce claim in the circuit court, superior court, or
probate court in which the lien was perfected, making all other
parties of interest respondents. § 32-33-4-4.
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STATE
STATUTE
COMMENTS
IOWA
Iowa Code §§ 582.1 – 4.
Hospital Lien.
A hospital that recovers from a judgment, verdict, or settlement
pursuant to this chapter shall be responsible for the pro rata
share of the legal and administrative expenses incurred in
obtaining the judgment, verdict, or settlement. § 582.1A(5).
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STATE
STATUTE
COMMENTS
KANSAS
K.S.A. §§ 65-406 – 409.
Lien of Operator.
The lien does not attach to workers’ compensation benefits. §
65-406(b).
In the event the claimed lien is for the sum of $5,000 or less, it
shall be fully enforceable as contemplated by subsection (a) of
this section. In the event the claimed lien is for a sum in excess
of $5,000, the first $5,000 of the claimed lien shall be fully
enforceable as contemplated by subsection (a) of this section,
and that part of the claimed lien in excess of $5,000 shall only
be enforceable to the extent that its enforcement constitutes
an equitable distribution of any settlement or judgment under
the circumstances. In the event the patient or such patient’s
heirs or personal representatives and the hospital or hospitals
cannot stipulate to an equitable distribution of a proposed or
actual settlement or a judgment, the matter shall be submitted
to the court in which the claim is pending, or if no action is
pending then to any court having jurisdiction and venue of the
injury or death claim, for determination of an equitable
distribution of the proposed or actual settlement or judgment
under the circumstances. § 65-406(c).
KENTUCKY
No statutory provision in
Kentucky.
Any lien that is asserted appears to be asserted via assignment.
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STATE
STATUTE
COMMENTS
LOUISIANA
La. R.S. §§ 9:4751 – 4755.
Proceeds Recovered by
Injured Persons.
A health care provider, hospital, or ambulance that furnishes
services to an injured person shall have a privilege for the
reasonable charges or fees on the net amount payable to the
injured party out of the total amount of recovery had, collected,
or to be collected, whether by judgment, settlement, or
compromise, for a responsible party. § 9:4752.
Any party who has been given notice of the lien has the right to
request, via certified mail, am itemized copy of all charges from
the provider. If the request is not complied with within 30 days,
the lien privilege is dissolved and ineffective. § 9:4755.
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STATE
STATUTE
COMMENTS
MAINE
Maine Revised Statutes
§§ 10:3411 – 3415.
Hospital Services.
Every licensed hospital is entitled to a lien for reasonable
charges for care, treatment, and maintenance of an injured
person upon any and all causes of action, suits, claims,
counterclaims or demands accruing to the person to whom
such care, treatment or maintenance was furnished, or to the
legal representatives of such person, on account of injuries
giving rise to such causes of action and which necessitated such
hospital care, treatment and maintenance. § 3411.
No lien is allowed against any person who is eligible for financial
assistance under the catastrophic illness program, Title 22, §
3185. § 3411.
The lien does not attach to any workers’ compensation
benefits. § 3411.
For the purposes of determining the reasonableness of the
hospital charges, the hospital shall, at the written request of the
person alleged to be liable, or his insurance carrier, make
available any hospital records which may be pertinent to
determining the reasonableness of the hospital charge, but in
no event shall they disclose any other records which it may
have;  including but not limited to, records or reports with
regard to the nature of the injury of the patient, the nature of
his condition or the state of his recovery. § 3412.
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STATE
STATUTE
COMMENTS
MARYLAND
Md. Code §§ 16-601 –
605.
Hospital’s Lien.
The lien in Maryland is only for 50% of the recovery or sum
which the patient may collect in judgment, settlement, or
compromise. § 16-601(a).
A hospitals lien is subordinate to an attorney’s lien for services
rendered in collecting or obtaining damages. § 16-601(c).
The lien does not attach to any workers’ compensation
benefits. § 16-601(a).
MASSACHUSETTS
M.G.L.A. 111 §§ 70A – D.
Hospital Liens.
Any hospital shall have a lien for the reasonable and necessary
charges of such hospital, not exceeding, however, the amount
which would be charged in a ward of such hospital, and any
health maintenance organization which has furnished health
services, and any hospital, medical, or dental service
corporation which has provided benefits for covered services
furnished to a person injured in such an accident shall, subject
to the provisions of § 70B, have a lien for such benefits, upon
the net amount payable to such injured person, his heirs or
legal representative out of the total amount of any recovery or
sum had or collected or to be collected, whether by judgment
or by settlement or compromise, from another person as
damages on account of such injuries. § 70A.
The lien of any attorney shall have precedence over the lien
created under this section. § 70A.
MICHIGAN
No statutory provision in
Michigan.
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STATE
STATUTE
COMMENTS
MINNESOTA
Minn. Stat. §§ 514.68 –
72.
Hospital Charges.
The filing of such claim or lien shall be notice thereof to all
persons, firms, or corporations liable for such damages whether
or not they are named in such claim or lien. § 514.69.
Any person, firm, or corporation operating a hospital in this
state shall have a lien for the reasonable charges for hospital
care of an injured person upon any and all causes of action
accruing to the person to whom such care was furnished, or to
the legal representatives of such person, on account of injuries
giving rise to such causes of action and which necessitated such
hospital care, subject, however, to any attorney’s lien. § 514.68.
Minnesota gives two years to seek recovery of the lien from a
party who was placed on notice of the lien. § 514.71.
The lien does not attach to any workers’ compensation
benefits. § 514.72.
MISSISSIPPI
No statutory provision in
Mississippi.
Mississippi limited hospital liens for treatment of burn care
only. However, the statutes providing for this lien were
repealed effective July 1, 2019.
MISSOURI
Mo. Rev. Stat. §§ 430.225
– 250.
Liens of Hospitals and
Health Practitioners.
Missouri mandates that hospitals pay a proportionate share of
recovery expenses if the lien is over 50% of the total net
proceeds. The net proceeds are calculated after attorneys’ fees
are taken out of the recovery amount. § 430.225(3).
Hospital liens do not extend to rights an injured person may
have under first-party insurance coverage which they, their
family, or their employers may have procured for the injured
person’s benefit. This includes UM benefits. Such first-party
insurance coverage cannot fairly be construed to fall within §
430.235’s reference to “claims ... which such injured person
may have ... against the person or persons causing such injury.”
Truman Medical Center, Inc. v. Progressive Casualty Ins. Co., 597
S.W.3d 362 (Mo. App. 2020).
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STATE
STATUTE
COMMENTS
MONTANA
Montana Code Ann. §§
71-3-1111 – 1118.
Physician, Nurse, Physical
Therapist, Occupational
Therapist, Acupuncturist,
Chiropractor, Dentist,
Psychologist, Licensed
Social Worker, Licensed
Professional Counselor,
Hospital, Optometrist,
Naturopathic Physician,
Podiatrist, Ambulance
Service, Rehabilitation
Facility, Long-Term Care
Facility, and Outpatient
Center for Surgical
Services Lien Act.
Workers’ compensation benefits are excluded. § 71-3-1118.
The Act specifically mentions that the lien is created against
both a liable party and if a person is insured or a beneficiary
under insurance. § 71-3-1112.
Notice is also preserved if an action has been commenced and
the lien notice is filed in the office of the clerk of court in which
the action is pending. § 71-3-1116.
NEBRASKA
Neb. Rev. Stat.
§§ 52-401 – 402.
Liens.
Workers’ compensation benefits are excluded. § 52-401.
If there is an action already filed, it shall be sufficient to file the
lien notice in the pending action. § 52-401.
• Liability carrier directly liable to provider when it settles
with injured party after perfection and impairs lien. W.
Nebraska Gen. Hosp. v. Farmers Ins. Exch., 475 N.W.2d
901 (Neb. 1991).
• Liability carrier can impair provider’s lien when it does
not include provider on settlement check, even after
receiving assurance from counsel that all liens would be
satisfied. Alegent Health v. Am. Family Ins., 656 N.W.2d
906 (Neb. 2003).
• Attorney lien trumps provider lien. § 52-401.
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STATE
STATUTE
COMMENTS
NEVADA
Nev. Stat. §§ 108.585 to
108.660.
Liens of Hospitals.
When a patient claims damages from a third party, the hospital
has a lien on any recovery to the extent of the amount due the
hospital for reasonable value of the hospitalization rendered
before date of any third-party recovery, unless workers’
compensation benefits are paid. § 108.590.
No lien is allowed for hospitalization received by a patient after
a third-party settlement. § 108.600.
Lien does not extend to any sum incurred by the patient as
attorneys’ fees, costs, and expenses. § 108.600.
If patient has health insurance and hospital has a contractual
agreement with that health insurer and wishes to perfect a lien,
the hospital must send, within 90 days after discharge, notice
of intent to file a lien by registered or certified mail to third-
party carrier, if known, and the patient and his attorney. §
108.605.
Within 30 days after sending notice of intent, hospital must first
attempt to collect from health insurance under § 449A.159. §
108.605(2).
If patient receives tort settlement after notice of intent to file a
lien is received, he must provide written notice to the hospital
of the recovery and the third-party carrier must proceed as if
lien is perfected. § 108.605(3).
Tortfeasor and third-party carrier liable to hospital for 180 days
after settlement if they don’t pay hospital lien. § 108.620.
If patient eligible for Medicare, Medicaid, etc., hospital limited
to 55% of the charges billed. § 108.655.
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STATE
STATUTE
COMMENTS
NEW HAMPSHIRE
N.H. Stat. §§ 448-A:1 to
448-A:4.
Liens in Favor of Hospitals
and Home Health Care
Providers.
Every hospital licensed in N.H. who furnishes medical or other
services to a patient not covered by workers’ compensation has
a lien on any claim or third-party cause of action against a
tortfeasor. § 448-A:1.
The third-party tortfeasor must disclose the name of his
insurance carrier upon receipt of notice. § 448-A:2.
After receiving notice, the tortfeasor and his insurance
company, if they settle the third-party case with the
patient/injured person without repaying the lien, remain liable
to the hospital or HHCP for one year from the date of
settlement, and this liability can be enforced by a suit against
such person or insurance company. § 448-A:3.
The town or city clerk must maintain and provide a book or card
filing system to be called the “hospital and home health care
provider lien docket.” It must contain the name of the patient,
tortfeasor, and hospital or HHCP, and may charge a fee of $15
for filing the lien. § 448-A:4.
NEW JERSEY
N.J. Stat. §§ 2A-44-35 to
2A-44-46.
Liens/Hospitals and
Physicians.
Every hospital and nursing home and every physician or dentist
have a lien against any personal injury claim of patient. § 2A-
44-36.
Lien attaches to all claims, suits, action which patient has
against tortfeasor responsible for injuries up to date of third-
party settlement. § 2A-44-37.
Lien amount may not exceed “ward rates” and cannot exceed
amount of third-party recovery. § 2A-44-38. For nursing home
limited to per diem rate. § 2A-44-39.1.
No lien if workers’ compensation. § 2A-44-40.
Clerk of court must maintain hospital lien docket, listing name
of injured person. Clerk can receive fee for filing of same. § 2A-
44-41.
No release by patient is valid after filing lien and tortfeasor
remains liable to hospital for period of one (1) year. They can
contest the charge. § 2A-44-43.
Tortfeasor has right to examine statement of charges. § 2A-44-
45.
Lien must be discharged and released upon payment. § 2A-44-
46.
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STATE
STATUTE
COMMENTS
NEW MEXICO
N.M. Stat. §§ 48-8-1 to
48-8-7.
Hospital Liens.
Every hospital in state has lien on third-party recover (not
including attorneys’ fees), whether by settlement, judgment, or
compromise. § 48-8-1.
Tortfeasor and its carrier liable if they settle after lien is filed,
up to one year after settlement. § 48-8-3.
County clerk will maintain hospital lien index. § 48-8-4.
Hospital must release lien when satisfied. § 48-8-5.
Hospital has lien only; no interest in the amount or manner of
any settlement or claim filed. § 48-8-7.
NEW YORK
N.Y. Lien Law § 189.
Other Liens on Personal
Property.
Every charitable hospital and every state, county town or village
operating a hospital has a lien on all causes of action the patient
has against tortfeasor. § 189(1).
Lien is for emergency services treating personal injuries
received within one (1) week prior to receiving treatment or
admission to hospital. § 189(1).
Lien attaches to settlement with any other person, or persons
or corporation claimed or alleged to be liable for said injuries. §
189(2)(a)(ii).
Lien only attaches to wrongful death recovery if medical
expenses are recovered by patient in settlement. § 189(2)(b).
No release is valid against such perfected lien. Hospital can
pursue action against tortfeasor for one year from date of such
notice. § 189(3).
County clerk must keep hospital lien docket. § 189(4).
Tortfeasor or its carrier can examine hospital billing and records
except for confidential records. § 189(5).
Lien doesn’t attach to workers compensation. § 189(6).
Patient can apply for order determining the validity of lien. If it
appears that there is a bona fide dispute as to the charges,
there must be an immediate hearing to determine the amount
of the reasonable charges of such hospital § 189(6-a).
Lien is subordinate to attorneys’ fees. § 189(7).
Hospital lien valid for 10 years. § 189(11).
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STATE
STATUTE
COMMENTS
NORTH CAROLINA
N.C.G.S. §§ 44-49 to 44-
51.
Liens Upon Recoveries for
Personal Injuries to
Secure Sums Due for
Medical Attention, Etc.
Creates lien on personal injury recovery in favor of any person,
corporation, State entity, municipal corporation or county to
whom the person so recovering, or the person in whose behalf
the recovery has been made, may be indebted for any drugs,
medical supplies, ambulance services, services rendered by any
physician, dentist, nurse, or hospital, or hospital attention or
services. § 44-49.
Lien attaches to all funds paid to [patient] in compensation for
or settlement of the injuries, whether in litigation or otherwise.
§ 44-50.
Lien capped at 50% of recovery after attorney’s fees are
deducted. § 44-50.
Provider/lienholder entitled to settlement distribution sheet
(“a certification with sufficient information to demonstrate that
the distribution was pro rata and consistent with this Article”).
Is subject to being bound by any confidentiality. § 44-50.1.
If lien contested, claim must be fully established and
determined. § 44-51.
When third-party carrier settles with unrepresented patient
and does not have valid notice of a claim for medical services
creating a medical lien on settlement, unless there is valid
assignment of rights, carrier does not have valid notice of a lien.
Smith v. State Farm Mut. Auto. Ins. Co., 358 N.C. 725 (N.C.
2004).
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STATE
STATUTE
COMMENTS
NORTH DAKOTA
N.D. Stat. §§ 35-18-01 to
35-18-11.
Hospital Lien.
Hospital has lien for the reasonable value of services rendered
to a patient injured in an accident. It attaches to all personal
injury claims, settlements, etc. as well as to any “insurance or
indemnity payable to the injured person by any insurer.” § 35-
18-01.
Clerk of court will charge a fee (§ 37-05.2-03(1)(d)), file-stamp
lien statement, and keep indexed. §35-18-04.
Filing of lien statement is constructive notice to all persons of
the hospital’s claim against tortfeasor and its insurer, and no
release is valid to release this claim. § 35-18-05.
Hospital can enforce its lien by civil action against the tortfeasor
and its insurer and even a judgment against them does not bar
the hospital from collecting its lien unless they have already
paid the hospital. § 35-18-06.
Any judgment in action for damages must contain reference to
the lien and hospital has 60 days to bring action to enforce lien
thereafter. § 35-18-07.
If patient has insurance policy/contract (non-workers
compensation) providing for indemnity or compensation for
hospital charges, the hospital also has a lien on such benefits,
and the policy/contract can pay off the lien which constitutes a
release of that party. § 35-18-08.
Liable party can inspect hospital records. § 35-18-09.
Action on lien must be filed within one year after filing lien. §
35-18-10.
OHIO
No statutory provision in
Ohio.
Ohio is one of nine states without statewide lien laws.
OKLAHOMA
42 Okla. Stat. §§ 43, 44.
Liens.
Hospital has lien on any third-party recovery for reasonable and
necessary charges up to date of payment. Lien subject to
attorneys’ fee lien. Doesn’t apply if workers’ compensation
applies. Lien also applies to medical diagnostic imaging
facilities. § 43.
Lien can be enforced by civil action in district court of county
where lien was filed if brought within one year after hospital
becomes aware of final judgment or settlement. § 44.
Physician has identical lien and procedure. § 46.
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STATE
STATUTE
COMMENTS
OREGON
Or. Stat. §§ 87.555 -
87.585.
Medical Services Lien.
Or. Stat. §§ 87.607 -
87.633.
Ambulance Services Lien.
Hospital, physician, nurse practitioner, and physician assistant
have lien on any sum awarded to or recovered by the injured
person for the reasonable value of the medical treatment
rendered prior to the recovery. No lien if workers’
compensation involved. Lien extends to PIP policy. If not
enough funds to satisfy all liens, the tortfeasor’s liability carrier
must prorate the available funds without regard to the
sequence of filing notice of liens, in proportion to the amount
due each for services rendered. § 87.555.
No lien once a settlement has been reached. Attorneys’ fees
take priority. No lien on PIP payments made before the lien was
filed. § 87.560. Form of Notice of Lien. § 87.570.
Third-party carrier liable to hospital or physician for reasonable
value of services if it receives notice of lien and still settles
without paying provider. Action by hospital/physician must be
commenced with 180 days after the settlement/payment. §
87.581.
Lien can be foreclosed by filing suit in circuit court and both lien
and reasonable attorneys’ fees “at trial” can be recovered. §
87.585.
PENNSYLVANIA
No statutory provision in
Pennsylvania.
Pennsylvania is one of nine states without statewide lien laws.
RHODE ISLAND
R.I. Stat. §§ 9-3-4 to 9-3-
14.
Liens Against Causes of
Action.
Any hospital (private, public) has lien on third-party action of
patient for the “reasonable and necessary charges” of the
hospital up to the date of the settlement. No lien if covered by
workers’ compensation and lien does not supersede attorney’s
fee lien. § 9-3-4.
After notice of lien filed, tortfeasor’s carrier is liable to hospital
if the lien is not repaid in a third-party settlement, for up to one
year. § 9-3-6.
SOUTH CAROLINA
No statutory provision in
South Carolina.
South Carolina is one of nine states without statewide lien laws.
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STATE
STATUTE
COMMENTS
SOUTH DAKOTA
S.D. Stat. §§ 44-12-1 to
44-12-8.
Hospital Liens.
Any hospital (private, public) has lien on third-party action of
patient for the “reasonable and necessary charges” of the
hospital up to the date of the settlement. § 44-12-1.
Lien doesn’t affect patient/attorney contract. § 44-12-2.
No lien if covered by workers’ compensation. § 44-12-3.
Hospital must first submit bill/charges to third-party
tortfeasor/carrier. § 44-12-3.1.
Tortfeasor must divulge name of liability carrier upon request
from hospital. § 44-12-7.
Settlement of third-party case without paying lien makes
tortfeasor liable for lien for one (1) year. § 44-12-8.
Tortfeasor is permitted to examine the billing/records of the
hospital. § 44-12-9.
TENNESSEE
Tenn. Stat. §§ 29-22-101
to 29-22-107.
Hospital Liens.
Any hospital (private, public) has automatic lien up to 1/3 of the
third-party recovery. § 29-22-101(b)
Hospital lien subordinate to attorney’s fee lien, but only if
recovery is insufficient to pay both lien and fees. § 29-22-
101(b); Breazeale v. Hensley, 2009 WL 196026 (Tenn. App.
2009). It is also subordinate to mechanic’s lien if auto involved.
§ 29-22-101(b).
Third-party release not valid unless lienholder joins and signs
release. Lienholder has action against tortfeasor. Suit can be
brought in lienholder’s county. § 29-22-104.
Third party cannot include name of hospital/lienholder on
settlement check. § 29-22-106.
Hospital has no independent action against tortfeasor outside
of lien on third-party action. § 29-22-107.
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STATE
STATUTE
COMMENTS
TEXAS
V.T.C.A., Property Code §§
55.001 to 55.008.
Hospital and Emergency
Medical Services Liens.
Lien on cause of action of anyone “who receives hospital
services for injuries caused by an accident that is attributed to
the negligence of another person.” Lien attaches to patient,
attorney, and liability carrier. Emergency medical services
provider does not need to provide notice if notice given to
patient at time services provided as set forth in § 55.005(e).
Lien applies only when patient is admitted to hospital within 72
hours of accident and extends to both admitting hospital and
hospital to whom patient transferred. § 55.002.
Lien does not attach to UM/UIM, PIP, Med Pay, or Workers’
Compensation benefits. It attaches to Occupational Accident
policy.
Hospital must make records concerning the services provided
available to the patient or his attorney as promptly as possible.
§ 55.008(a).
“Emergency medical services provider” also has lien if services
within 72 hours of accident and in county with population of
800,000 or less. § 55.008(2)(c).
Common Fund Doctrine does not apply to hospital liens.
Bashara v. Baptist Memorial Hosp. System, 685 S.W.2d 307
(Tex. 1985).
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STATE
STATUTE
COMMENTS
UTAH
Utah Stat. §§ 38-7-1 to
38-7-8.
Hospital Lien Law.
Hospital has a lien on third-party recovery after attorneys’
fees/costs paid. No lien on recoveries less than $100. Lien is for
amount of reasonable, usual, and necessary hospital charges.
No lien if workers’ compensation or private health insurance
cover the accident unless health insurer denies coverage or
doesn’t pay within 180 days. Lien must be withdrawn when
private health insurer pays the contracted amount. Hospital
may assert lien for copayment or deductible owed by the
patient. § 38-7-1.
Third party carrier who received notice of lien is liable for lien if
it settles without paying lien, for period up to one (1) year from
date of third-party settlement. Hospital can file suit against
third-party to enforce lien and recover reasonable attorneys’
fees and costs of litigation and lien filing. § 38-7-3.
Once lien is paid, hospital must execute and file a release of lien
and mail a copy of release of lien to patient. § 38-7-5.
Hospital does not have to pay any costs of collection. Lien
Statute merely creates a priority system for payment. The
hospital lien is to be paid in full after the attorney's fees and
costs are paid from the fund. Bryner v. Cardon Outreach, LLC,
428 P.3d 1096 (Utah 2018).
VERMONT
18 V.S.A. §§ 2251 – 2256.
Lien for Services
Rendered Accident
Victims.
Lien applies to any recover from an accident not covered by
workers’ compensation but does not attach to one-third of the
recovery or $500, whichever is less. § 2251.
Third-party carrier liable for one year from date of
settlement/payment, to the hospital for the amount of the lien,
and hospital can, within that year, enforce its lien by civil action
against third-party carrier or person making payment. After
one-year lien is void. § 2253.
Every town clerk must keep hospital lien docket properly
indexed under name of injured patient. § 2254.
Hospital/town must file a certificate of discharge within 30 days
after lien is satisfied. § 2256.
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STATE
STATUTE
COMMENTS
VIRGINIA
Va. Code §§ 8.01-66.2 -
8.01-66.12.
Lien for Hospital, Medical
and Nursing Services
Every hospital, nursing home, licensed physician, registered
nurse, registered physical therapist, pharmacy, or ambulance
service has a lien for services rendered on care to any person
injured due to third-party tortfeasor. The lien limited to the just
and reasonable charge for the services rendered, not exceeding
$2,500 (hospital or nursing home), $750 (physician, nurse,
physical therapist, or pharmacy), and $200 (ambulance
service). § 8.01-66.2.
Lien inferior to attorneys’ fees. § 8.01-66.3.
Any city, corporation, or person who pays the charges for which
a lien is provided is subrogated to such lien. § 8.01-66.4.
WASHINGTON
R.C.W.A. §§
60.44.010 -- 60.44.060.
Lien of Doctors, Nurses,
Hospitals, Ambulance
Services
Allows lien for hospitals (public and private), nurse
practitioners, physicians, and surgeons rendering service,
transportation, and care. Allows lien on any recovery in third-
party tort claim, but not workers’ compensation benefits. Lien
cannot exceed 25% of an award, verdict, report, decision,
decree, judgment, or settlement. § 60.44.010.
In order to enforce hospital lien against portion of settlement,
claimant must establish alleged tortfeasor’s negligence; fact
that alleged tortfeasor has made payment or settlement
constitutes prima facie evidence of negligence, rather than
conclusive evidence, and may be rebutted. U.S. v. Deaconess
Medical Center Empire Health Service, 994 P.2d 830 (Wash.
2000).
WEST VIRGINIA
No statutory provision in
West Virginia.
West Virginia is one of nine states without statewide lien laws.
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STATE
STATUTE
COMMENTS
WISCONSIN
Wis. Stat. § 779.80.
Hospital Liens.
Only charitable hospitals may file a lien. § 779.80(1); Spence v.
Regions Hospital, 384 F.Supp.2d 1313 (W.D. Wis. 2005).
Hospital has lien on any cause of action or claim against
tortfeasor. § 779.80(2).
Section 779.80 may be broad enough to allow lien against
UM/UIM and Med Pay benefits. No case law to date.
Clerk of the court must enter hospital lien in judgment and lien
docket. § 779.80(3)(a).
Once lien is properly perfected, a release will not be valid
against a perfected hospital lien and third-party carrier remains
liable to hospital for amount of its lien for one year. § 779.80(4).
Lien is subordinated to attorney’s fees and actual taxable court
costs and disbursements. § 779.80(5).
Lien does not attach to workers’ compensation. § 779.80(6).
If attorney does not disclose lien to third-party carrier, carrier
and/or its attorney should ascertain if any liens.
Hospital can enforce a hospital lien on a Medicaid recipient’s
third-party settlement as an alternative to billing Medicaid.
Gister v. American Family Mut. Ins. Co., 818 N.W.2d 880 (Wis.
2012).
WYOMING
No statutory provision in
Wyoming.
Wyoming is one of nine states without statewide lien laws.
These materials and other materials promulgated by Matthiesen, Wickert & Lehrer, S.C. may become outdated or superseded as time goes by. If you should have questions regarding
the current applicability of any topics contained in this publication or any publications distributed by Matthiesen, Wickert & Lehrer, S.C., please contact Gary Wickert at
gwickert@mwl-law.com. This publication is intended for the clients and friends of Matthiesen, Wickert & Lehrer, S.C. This information should not be construed as legal advice
concerning any factual situation and representation of insurance companies and\or individuals by Matthiesen, Wickert & Lehrer, S.C. on specific facts disclosed within the
attorney\client relationship. These materials should not be used in lieu thereof in anyway.