Detailed Answer
This guide explains how a claimant in Ohio can find and resolve medical liens that affect a personal injury settlement. It assumes no prior legal knowledge and outlines practical, step-by-step actions you can take. This is educational information only and not legal advice.
What is a medical lien and why it matters
A medical lien is a claim against settlement or judgment proceeds by a medical provider, health insurer, or government benefit program that paid for treatment related to the injury. Liens reduce the money you receive from a settlement, and some liens (like Medicare or private-insurer subrogation) must be satisfied before funds are distributed.
Common types of medical claims you will encounter in Ohio
- Private medical-provider or hospital liens (where a provider claims a right to be paid from proceeds).
- Health-insurer subrogation or reimbursement demands (including ERISA plans).
- Medicare conditional payments and recovery demands (federal).
- Ohio Medicaid recovery or estate claims.
- Workers’ compensation liens (if WC paid benefits).
Step-by-step process to identify and resolve liens
1) Collect and organize all medical and billing records
Gather every medical record, itemized bill, Explanation of Benefits (EOB), and receipts for payments related to the injury. These documents help identify who paid for care and whether a provider has asserted a lien.
2) Ask opposing counsel and your insurer for payor information
When you make a demand or begin settlement talks, request that the defendant’s insurer and your own carrier tell you whether any third parties (insurers, providers, government payors) have asserted claims. Put requests in writing and keep copies.
3) Request formal lien or subrogation statements from all potential claimants
Contact each provider, private insurer, and any government program that may have paid. Ask for a written statement (often called a “lien letter,” “subrogation demand,” or “conditional payment letter”) that lists:
- Dates of service
- Itemized charges and what was actually paid
- The legal basis for the claim (assignment, subrogation, statutory right)
- Proof that the claimant served a timely lien notice (if applicable)
4) For Medicare: obtain a conditional payment letter and final demand from CMS
If you are a Medicare beneficiary, Medicare may have paid for treatment and can demand repayment from your settlement. Use the Medicare coordination of benefits and recovery resources to request a conditional payment report and a final demand before settlement. See CMS recovery resources: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Recovery/. Failure to address Medicare’s recovery claim can lead to future demands and interest.
5) For Ohio Medicaid: notify Ohio Department of Medicaid / recovery unit
If Medicaid paid any care, Ohio Medicaid may have a recovery claim. Contact the Ohio Department of Medicaid or the Medicaid recovery unit to request a written statement of any claim related to your injury. Ohio Medicaid rules govern how Medicaid recovery is sought and priority of payment.
6) Check private-insurer subrogation and ERISA plan rules
Private health plans often have subrogation or reimbursement rights. For ERISA plans (federal law covering most employer-sponsored plans), the plan document may require repayment from settlement proceeds and federal law can preempt some state rules. Ask the plan for a written demand and copies of the plan’s relevant provisions. You can find general ERISA enforcement provisions at 29 U.S.C. §1132 (consult counsel when ERISA issues arise).
7) Review and challenge amounts and legal bases
Not every bill or demand is correct. Common challenges include:
- Duplicate billing or charges not tied to the injury
- Payments already made or adjusted by an insurer
- Procedural defects in a asserted lien (lack of written notice, missing assignment)
Ask for itemized bills and supporting records. Dispute errors in writing and retain proof of delivery.
8) Negotiate reductions and lien releases
Providers and insurers often accept less than the full billed amount. Negotiation strategies include offering a percentage of billed charges, tying payment to proof of settlement, or requesting a lien release letter stating that the claimant will accept a negotiated sum as full satisfaction. Get any agreement in writing before paying.
9) Use escrow or a court-approved distribution when dispute exists
If parties cannot agree before settlement, consider placing disputed funds in an escrow account or asking the court to approve a settlement and distribution plan. This protects you from paying out settlement proceeds that a claimant later asserts are owed. If a case is in litigation, many judges will not approve a settlement that fails to address known lien claims.
10) Obtain releases and lien waivers before disbursing funds
Before distributing settlement money, secure written releases and lien waivers from each claimant that accepted payment. The waiver should state the amount paid and that the claimant releases any further claim against the settlement. Keep copies with your file.
11) Document everything and keep copies
Keep records of all communications, demands, receipts, releases, and court orders. Good documentation protects you if a lien claimant later reasserts a demand.
Practical timeline
- Immediately after settlement demand: compile medical records and bills.
- 30–60 days before expected settlement: request lien letters from potential claimants, and request a Medicare conditional payment report if applicable.
- 2–3 weeks before settlement: negotiate with claimants and attempt to obtain written releases.
- At settlement: escrow disputed amounts or obtain court approval if disputes remain.
- After settlement: confirm lienors have been paid and that Medicare/Medicaid final demands are satisfied.
Relevant Ohio and federal resources
- Ohio Department of Medicaid: https://medicaid.ohio.gov/
- Centers for Medicare & Medicaid Services — Recovery and Conditional Payments: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Recovery/
- Ohio Revised Code and searchable statutes: https://codes.ohio.gov/ (search for specific statutes on hospital liens, subrogation, or Medicaid recovery)
- U.S. Department of Labor (ERISA overview): https://www.dol.gov/general/topic/health-plans/erisa
When to get a lawyer
Hire an Ohio personal injury attorney experienced in lien resolution if: multiple lienors assert large claims; Medicare/Medicaid recovery is involved; an ERISA plan asserts subrogation; or the defendant’s insurer will not resolve liens before disbursement. An attorney can negotiate reductions, prepare escrow or court papers, and protect your net recovery.
Disclaimer: This article is for educational purposes only and does not constitute legal advice. Laws and procedures change. For advice about your specific situation, consult a licensed Ohio attorney.
Helpful Hints
- Start lien discovery early — resolving claims often takes weeks.
- Request written lien or conditional payment letters from each claimant.
- Never assume a bill equals an enforceable lien; ask for legal authority in writing.
- If you are a Medicare beneficiary, get the CMS conditional payment report before settling.
- Negotiate — many providers accept a reduced lump-sum payment for a lien release.
- Use escrow or court approval when disputes exist to avoid personal liability for later claims.
- Keep a clear paper trail: copies of all demands, offers, payments, and releases.
- Consider counsel when ERISA plans or government payors (Medicare/Medicaid) are involved.
- Ask for lien releases that state the claimant waives all future claims related to the injury.
- Understand that paying a bill directly to a provider without a release can leave you open to later demands; always get a written release.