Detailed Answer: Steps to identify and resolve medical liens (New Hampshire)

If you were injured in New Hampshire and expect a personal injury settlement, medical providers, insurers, and government health programs may assert liens or subrogation claims against the settlement proceeds. A lien is a claim against your settlement to recover payments for care related to the injury. Follow the steps below to identify all possible lienholders and resolve their claims so you can finalize your settlement safely and fairly.

1. Understand who might have a claim.

   Potential claimants include:

   • Hospitals, physicians, clinics, surgeons, and other medical providers that treated you.
   • Health insurers (private insurance or employer plans) that paid medical bills—these plans often assert subrogation or reimbursement claims.
   • Medicare and Medicaid (NH Medicaid) — federal and state programs have mandatory recovery rights.
   • Ambulance providers, rehabilitation facilities, and sometimes employer benefit plans.
2. Compile records and a list of providers and payers.

   Ask for and keep copies of:

   • All medical bills, itemized statements, and explanations of benefits (EOBs) for treatment related to the injury.
   • Insurance correspondence showing payment or denial for the treatment (EOBs, remittance advices).
   • Provider names, addresses, dates of service, and account numbers.
3. Request lien or subrogation statements in writing.

   Contact each provider and insurer and request, in writing, a clear statement of any lien or subrogation claim: the amount claimed, basis for the claim, and supporting documentation (itemized bills, proof of payment, assignment or lien forms). Keep proof of your requests and their responses.

4. Check government benefit programs.

   If Medicare or New Hampshire Medicaid (NH Medicaid) paid for your care, those programs can require repayment from your settlement. For Medicare, the Medicare Secondary Payer rules apply and the Centers for Medicare & Medicaid Services (CMS) enforces recovery rights. See CMS information on Medicare coordination and recovery: CMS – Coordination of Benefits and Recovery. For general New Hampshire state health resources, see the New Hampshire Department of Health & Human Services: NH DHHS. To read New Hampshire statutes (for example to review relevant statutory rules that could affect procedural issues), use the New Hampshire Revised Statutes Annotated index: NH RSA Online.

5. Determine priority and enforceability.

   Not every bill will automatically become a valid lien against your settlement. The right to assert a lien or subrogation interest depends on contract terms, provider agreements, any assignments you signed, insurance plan terms, and applicable federal or state law. Some claims must be asserted within a certain timeframe or with specific notice. If a provider claims a “lien,” ask for the legal basis or statute that gives them that lien. If you cannot find a statutory basis, the claim may still be enforceable as an equitable lien or a subrogation claim—but that is a legal question often needing counsel.

6. Negotiate reductions early.

   Medical bills are commonly negotiated in personal injury cases. Providers and insurers often accept less than billed amounts when presented with a single-source settlement. Ask each lienholder for a written settlement or reduction offer and whether they will sign a release or lien waiver once paid. Many hospitals and providers have standard reduction policies for third‑party recoveries.

7. Allocate settlement funds and use escrow if necessary.

   Work with the opposing insurer, your attorney, and any lienholders to allocate settlement proceeds (e.g., to past medicals, future medicals, lost wages, pain and suffering). If disputes remain, the settlement can be structured with funds placed in escrow or a court-supervised fund while lien disputes are resolved.

8. Document releases and lien waivers in writing.

   Do not distribute settlement funds until you have written releases or lien waivers from all known lienholders, or until a court has determined the disposition of disputed claims. Obtain signed lien releases that explicitly state the provider releases any present or future claims against your settlement in exchange for the agreed payment.

9. If a lienholder sues or threatens suit, respond promptly.

   Promptly respond to any letters or lawsuits. Some NH courts allow lienholders to file motions seeking payment from settlement proceeds. Failing to defend or resolve the claim can expose you or the settlement funds to legal risk.

10. Consider involving counsel experienced in liens and subrogation.

    Attorney involvement is often the most efficient way to identify all lien claims, negotiate reductions, and protect your net recovery. If you have a contingency-fee attorney for your personal injury case, they typically coordinate lien resolution as part of settlement. If not, consider hiring counsel with experience in health-care lien and subrogation matters.

Special notes about Medicare and Medicaid

Medicare has mandatory recovery rights when Medicare paid for injury-related care. The Medicare Secondary Payer rules require that Medicare be repaid out of third-party settlements for treatment Medicare would otherwise have paid. Before settling, you (or your attorney) should notify Medicare and request a conditional payment amount so Medicare’s claim is quantified and potentially reduced. See CMS: Medicare coordination and recovery. For federal statutory language on Medicare’s recovery authority, see 42 U.S.C. § 1395y: 42 U.S.C. § 1395y (Cornell Legal Information Institute).

New Hampshire Medicaid (NH Medicaid) also may have a claim for recovery if it paid for care related to your injury. Contact NH DHHS (see NH DHHS) to identify any state recovery process or the appropriate unit within the agency to notify about third-party recoveries.

What to do if you cannot locate a lienholder but bills exist

Sometimes providers change names, sell accounts, or no longer respond. Keep thorough records of your outreach. Consider a title search or hire a professional claims administrator to identify potential claimants. If a previously unknown party later asserts a claim, having documented good-faith efforts to identify and resolve claims will help protect you and your settlement.

New Hampshire procedural resources

• New Hampshire Revised Statutes (RSA) index: https://www.gencourt.state.nh.us/rsa/html/
• NH Department of Health & Human Services: https://www.dhhs.nh.gov/
• CMS — Medicare coordination and recovery: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview
• Federal statute on Medicare recovery (for background): 42 U.S.C. § 1395y

When to get a lawyer

Hire an attorney if you see any of the following:

• Multiple lienholders with large claimed amounts.
• A government program (Medicare/Medicaid) has paid for your care.
• Disputes arise about whether treatment was related to the injury.
• Any lienholder threatens suit or files an action to attach your settlement.

Helpful Hints

• Start early: identify potential liens as soon as you plan to settle—don’t wait until the settlement check is ready.
• Get itemized bills and EOBs: generic bills make negotiation harder.
• Ask for a written lien release in exchange for payment—verbal promises are not enough.
• Document every communication (mail, email, phone logs) with providers and insurers.
• Ask whether a provider has a written reduction policy for third‑party recoveries; many hospitals and providers will accept less than the billed amount.
• If Medicare or Medicaid is involved, request conditional payment or recovery documentation so you know the federal/state claim amount before settling.
• Consider escrow: if one or more lienholders refuse to cooperate, escrow a disputed portion of the settlement while disputes are resolved.
• Keep a copy of the final release language before signing any settlement that purports to resolve all claims—ensure releases match the negotiated results with lienholders.

Final note and disclaimer

This article explains common steps claimants take to identify and resolve medical liens on personal injury settlements in New Hampshire. It is for general information only and is not legal advice. I am not a lawyer. Laws change and specific facts can affect outcomes; consult a licensed New Hampshire attorney if you need advice tailored to your situation.