Detailed Answer
If you are resolving a personal injury claim in Nevada, medical liens and claims by health insurers often affect how much you actually receive. Follow these clear steps to identify, evaluate, and resolve lien claims so you can close your case safely.
1. Understand what a medical lien or claim can be
Medical liens or claims include amounts asserted by hospitals, doctors, clinics, ambulance companies, health insurers, workers’ compensation carriers, Medicare, and Medicaid. In Nevada, private providers and some public entities can assert liens or claims against your personal-injury recovery under Nevada law (see NRS Chapter 108 — Liens).
2. Prevent premature distribution of settlement funds
Do not agree to disburse settlement money until liens and subrogation claims are identified and resolved in writing. If funds leave your attorney’s trust account before lien resolution, you risk personal liability for unpaid liens.
3. Gather documents the claimant and counsel need
- All medical records and itemized bills related to the injury.
- Insurance explanation of benefits (EOBs), carrier correspondence, and assignment documents.
- Settlement agreement terms and any prior lien releases or bills.
- Any notices you received about liens or claims.
4. Identify potential lienholders
Common lienholders:
- Hospitals and treating physicians.
- Ambulance services and imaging centers.
- Private health insurers and ERISA plans (they can assert subrogation rights).
- Medicare and Medicaid (federal and state programs have mandatory recovery rules).
- Workers’ compensation carriers (if the injury overlaps).
Ask medical providers and all insurers for written statements of any lien, including an itemized bill, the basis for the claim, and any supporting assignment or notice.
5. Verify that each asserted lien is timely and properly filed
In Nevada, statutory rules control how and when liens attach and how they are enforced. Check whether the lien was perfected according to statutory requirements in NRS Chapter 108 and local recording requirements. If a provider never filed a required notice or missed a statutory deadline, their claim may be weaker or unenforceable.
6. Request written, itemized lien statements and legal authority
For each claim, request:
- Itemized, date-by-date medical charges and payments.
- A description of the legal basis for the lien or subrogation right (assignment, contract, statute, or plan language).
- Documentation of any payments already made by insurers or government programs.
7. Evaluate and dispute invalid or excessive claims
Common dispute grounds:
- Duplicate billing or billing for unrelated care.
- Charges that exceed customary, reasonable, or allowable amounts.
- No written assignment or failure to meet statutory notice/filing requirements.
- Worker’s compensation or other payer priority conflicts.
Use itemized bills, medical records, and insurer EOBs to spot improper charges. If a statutory defect exists (for example, a lien was not filed as required), you can demand release or file a motion to extinguish a lien in court.
8. Negotiate reductions and obtain releases in writing
Most providers will accept less than the full billed amount. Typical outcomes:
- Percentage reduction (e.g., 30–60% off billed charges).
- Accepting insurer-allowed amounts as full satisfaction.
- Structured releases tied to specific settlement proceeds.
Get a signed, written lien release or satisfaction document from each claimant before paying funds out. The release should state the claim is paid in full or specify any reserved amounts.
9. Handle government payers carefully (Medicare and Medicaid)
Medicare and Medicaid have mandatory recovery/subrogation rights. You must notify Medicare and follow the Medicare Secondary Payer and recovery process. Contact the Nevada Medicaid agency (Nevada Division of Health Care Financing and Policy) for state Medicaid recovery rules. If Medicare or Medicaid has paid related care, they may require repayment from your settlement. Failure to comply can jeopardize future benefits or trigger federal enforcement.
10. Use escrow, interpleader, or court procedures if parties dispute
If lienholders dispute priorities or amounts, consider placing disputed funds into an interest-bearing escrow account or initiating an interpleader action. In Nevada, courts can resolve competing claims before disbursement to prevent personal liability.
11. Include lien resolution terms in the settlement agreement
Have the settlement agreement specify who is responsible for resolving liens, how disbursements will occur, and that settlement funds will not be released until releases are obtained. Your attorney can draft holdback terms to secure payment of negotiated lien amounts.
12. Final steps before disbursement
- Obtain written releases or court orders showing satisfied liens.
- Ensure Medicare/Medicaid conditional payment demands are addressed and obtain final demand or conditional payment resolution.
- Confirm all subrogation waivers or reductions are in writing.
- Document all payments and retain copies of releases for your records.
Key Nevada Legal Reference
Nevada’s statutory framework on liens is located in NRS Chapter 108 — Liens. That chapter and related statutes describe how liens attach, how they must be recorded, and enforcement procedures. Consult the chapter when evaluating recording and perfection issues.
What to expect on timing and cost: lien resolution can add weeks to months to closing, depending on the number and type of claimants. Negotiation often reduces the total lien amount, but government payers and ERISA plans can be less flexible and may require formal processes.
When to consult an attorney: If you face multiple lienholders, government payers (Medicare/Medicaid), or a dispute about lien priority or validity, speak with a Nevada personal injury attorney who routinely handles lien resolution and trusts/escrow handling. The attorney can help negotiate reductions, prepare holdbacks, or pursue court relief to clear title to settlement proceeds.
Disclaimer: This information explains general steps under Nevada law and is for educational purposes only. It is not legal advice. Consult a licensed Nevada attorney about your specific case before taking action.
Helpful Hints
- Start lien identification early—do it as soon as you consider settlement.
- Ask each provider for a written, itemized lien statement before signing anything.
- Never release settlement funds until you have signed releases or a court order resolving liens.
- Keep funds in an attorney trust or escrow account while resolving disputes.
- Remember Medicare/Medicaid recovery rules are strict—notify the relevant agencies and obtain final demand letters.
- Negotiate; many providers accept substantial discounts in exchange for prompt payment and a release.
- Request written agreements from health insurers or plan administrators that outline subrogation or reimbursement rights.
- If lienholders refuse to negotiate, consider asking the court to determine lien validity and priority before disbursing funds.