Understanding Medical and Chiropractor Liens in New Hampshire

Detailed Answer

When you resolve a personal-injury claim in New Hampshire, you often receive a settlement or judgment that compensates you for medical bills, lost wages, pain and suffering, and other losses. Third parties—medical providers, chiropractors, health insurers, Medicare, or Medicaid—may try to recover what they paid for your care from that settlement. Whether those payments get deducted from your settlement depends on the type of claim the provider has and the payer’s legal rights.

What a “lien” or claim means

A lien, subrogation claim, or assignment is a legal right to be paid from the proceeds of your case. Common forms you will see:

• Provider assignment: you signed an agreement allowing a provider (doctor, chiropractor) to be paid from any recovery you obtain.
• Equitable subrogation/reimbursement: a provider, or an insurer who paid medical bills, claims the right to be reimbursed from your recovery even if no written assignment exists.
• Government liens and conditional payment claims: Medicare and Medicaid (and other public programs) have statutory and regulatory recovery rights for amounts they paid on your behalf.

How New Hampshire law treats these claims

New Hampshire follows basic principles of assignment and equitable subrogation: if a provider has a valid assignment or a court recognizes a right to reimbursement, the provider can ask to be paid from the settlement. The precise mechanics and priority can vary depending on the parties involved and any written agreements. For general access to New Hampshire statutes and how state law is organized, see the New Hampshire Revised Statutes: https://www.gencourt.state.nh.us/rsa/html/indexes/default.html

Special rules for Medicare and Medicaid

If Medicare or New Hampshire Medicaid (Title XIX) paid for your medical care, federal and state rules require repayment from any settlement that compensates for medical expenses. Medicare’s recovery program is governed by federal law and regulations (Medicare Secondary Payer); CMS requires that conditional payments be identified and reimbursed from your settlement. See CMS on coordination of benefits and recovery: https://www.cms.gov/medicare/coordination-of-benefits-and-recovery/coordination-of-benefits-and-recovery-overview and the federal statute on Medicare secondary payer (42 U.S.C. §1395y): https://www.govinfo.gov/content/pkg/USCODE-2019-title42/html/USCODE-2019-title42-chap7-subchap18-partA-sec1395y.htm

Practical effect: will the lien reduce the money you get?

Yes, commonly. Typical pathway:

• Your attorney negotiates or litigates with the at-fault party’s insurer and obtains a settlement.
• The attorney requests payoff statements or lien letters from medical providers and from Medicare/Medicaid if applicable.
• Those liens or payoff demands are resolved—often by paying the full amount, a negotiated reduced amount, or by obtaining a written release—before the attorney distributes funds to you.

Which amounts come off first? Attorneys typically deduct attorney fees and case expenses per your contingency-fee agreement first, then pay valid liens and bills before distributing the remainder. But your attorney should explain the order and provide statements showing the math.

How chiropractors are treated

Chiropractors are health-care providers. If you signed an assignment of benefits or the chiropractor has a valid subrogation claim, the chiropractor can assert a claim against your recovery. Many chiropractors operate under written agreements that create a direct right to be paid from any settlement. As with other providers, an attorney can often negotiate a reduced payoff.

Common scenarios and what usually happens

• Private provider, no assignment: the provider may file a claim for reimbursement. The provider can sue to secure payment. Settlement funds are often used to satisfy a court-declared lien or negotiated reduction.
• Private provider with assignment: the provider has stronger, contract-based rights to be paid from proceeds.
• Health insurer subrogation (private insurer): the insurer may assert subrogation rights and seek reimbursement from your recovery, subject to contract terms and state law.
• Medicare/Medicaid: federal/state rules require repayment of conditional payments. You must address CMS conditional payment letters before distribution. See CMS recovery process above and contact New Hampshire DHHS for state Medicaid questions: https://www.dhhs.nh.gov/

Typical steps your attorney will take to protect you

1. Obtain itemized bills and written payoff figures from all providers and payers.
2. Notify Medicare/Medicaid and request conditional payment amounts if applicable.
3. Attempt to negotiate reduced lien amounts or obtain written lien releases.
4. Place disputed funds in escrow or file a motion in court asking a judge to clear the settlement if a lien is contested.
5. Distribute the remaining proceeds to you after lawful deductions.

Hypothetical example

Suppose you recover $50,000. Your attorney’s contingency fee is 33% ($16,667), leaving $33,333. Medical bills total $8,000 and a chiropractor claims $4,000. If you and the providers cannot negotiate reductions, those $12,000 may be paid from that $33,333, leaving you about $21,333. If you successfully negotiate down the chiropractor’s claim to $2,000 and the medical bills to $6,000, you keep more. The exact numbers vary; ask your attorney for a written accounting.

Helpful Hints

• Do not sign away your right to negotiate lien amounts without understanding the document. Ask your attorney to review any assignment or lien form before you sign.
• Get itemized medical bills and written payoff statements from every provider claiming a lien.
• Tell your attorney about any health insurance, Medicare, or Medicaid coverage immediately so they can address conditional-payment issues early.
• Negotiate. Providers often accept reduced lump-sum payoffs rather than their full billed amounts.
• Ask your attorney to place disputed portions of a settlement into escrow or to ask a court to approve the settlement to avoid personal liability if a lien later arises.
• Keep records. Save invoices, letters, and releases proving what was paid to providers and who released liens.
• Use state and federal resources: New Hampshire statutes and resources: https://www.gencourt.state.nh.us/rsa/html/indexes/default.html; New Hampshire DHHS (Medicaid): https://www.dhhs.nh.gov/; Medicare/CMS recovery rules: https://www.cms.gov/medicare/coordination-of-benefits-and-recovery/coordination-of-benefits-and-recovery-overview
• If a lien seems incorrect or excessive, ask your attorney about filing a petition to determine lien priority or to request a court-approved distribution.

When to consult an attorney

If providers assert liens, if Medicare/Medicaid claims repayment, or if multiple claimants dispute the settlement distribution, consult a New Hampshire personal-injury attorney. An attorney experienced in handling liens can: obtain accurate payoff statements, negotiate reductions, place funds in escrow, and—if necessary—seek court approval of distributions.

Disclaimer

This article provides general information about medical and chiropractor liens under New Hampshire law. It is not legal advice and does not create an attorney–client relationship. Laws change and facts matter; consult a licensed New Hampshire attorney about your specific situation.