Detailed answer — how liens and deductions typically work in North Dakota

When you recover money from a settlement (auto crash, slip and fall, etc.), several parties may assert a right to be paid from that recovery. Common claimants include:

• Medical providers (hospitals, clinics, chiropractors) who treated you.
• Your private health insurer (subrogation or contractual lien).
• Medicare or Medicaid (federal/state programs with statutory recovery rights).
• Workers’ compensation carrier (if the injury is work-related).

1. Medical and chiropractor claims — lien, assignment, or billing balance

In many cases a chiropractor or other provider will try to collect the unpaid balance for the care they provided. How they can do this depends on three things:

1. Whether state law or a recorded lien gives that provider a statutory lien on your cause of action or settlement;
2. Whether you signed an assignment or lien agreement at the time of treatment (some providers get you to assign your right to recover from a third party); and
3. Whether the provider is willing to negotiate a reduced payoff in exchange for immediate payment from settlement proceeds.

North Dakota does not give every treating provider an automatic, unlimited claim that wipes out your settlement. Many providers rely on assignment agreements (what you signed at intake) or on pursuing reimbursement through the usual collection and civil-judgment processes. That said, a hospital or an insurer may have stronger statutory or contractual rights than an individual chiropractor who never obtained an assignment.

2. Private insurer subrogation and contractual liens

If your health insurer paid bills for treatment, it often has a right to reimbursement (subrogation) from any third-party recovery. That right usually comes from your insurance contract. Your insurer may demand a portion of your settlement. In many cases the insurer will accept a negotiated “payoff” amount rather than full billed charges. You should not ignore written subrogation demands — they can turn into lawsuits or liens on your recovery.

3. Medicare and Medicaid recovery

Federal and state programs have statutory recovery rights. Medicare (federal) and Medicaid (state-administered) routinely pursue reimbursement for conditional payments and benefits paid related to an injury. These programs do not typically negotiate away their full right without a process; you or your attorney must notify them, request a conditional payment report, and follow their procedures for resolution.

For information from North Dakota about Medicaid and third-party liability, start with the North Dakota Department of Human Services: https://www.nd.gov/dhs. For federal Medicare recovery rules see the Centers for Medicare & Medicaid Services (CMS) guidance on Medicare Secondary Payer: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-Secondary-Payer. For federal Medicaid third-party liability guidance see: https://www.medicaid.gov/medicaid/eligibility/third-party-liability/index.html.

4. How settlement funds are commonly handled

Typical steps that affect whether liens are deducted:

• Before settlement you should provide your attorney and the payer(s) notice of the settlement demand or the pending settlement.
• Your attorney should obtain written payoff amounts from providers and written subrogation statements from insurers and government payors.
• Often settlement agreements place funds in escrow or a trust until all lien holders are satisfied or the parties reach an agreement about distribution.
• Some settlements include a court order or stipulated release that directs how lien claims are to be paid; in some jurisdictions, a court can approve distribution to protect the settlement proceeds while claims are resolved.

5. Can you negotiate or reduce liens?

Yes. Medical providers and private insurers frequently accept less than billed amounts to avoid collection disputes. Liability insurers often expect negotiation. Government payors (Medicaid and Medicare) have specific administrative processes that may or may not allow reductions, depending on the circumstances.

6. Practical example (hypothetical)

Hypothetical: You settle an auto case in North Dakota for $50,000. Your chiropractor’s unpaid billed charges are $6,000. Your private insurer paid $3,000 and asserts a subrogation interest. Medicaid paid $1,200 and may seek reimbursement.

Steps you or your attorney should take:

1. Get written payoffs: chiropractor payoff, insurer subrogation demand, Medicaid payoff or statement of claim.
2. Ask chiropractor if a reduced payoff will be accepted (for example, $2,000). Many providers will negotiate.
3. Notify Medicaid and Medicare (if applicable) and follow their required administrative procedures before disbursing funds.
4. Use escrow or court-approval procedures to avoid personal liability for paying the wrong party.

If all claimants are legitimate, the settlement fund will be reduced by those required payoffs. The exact amount you keep depends on negotiated payoffs and required statutory reimbursements.

7. What to do before you sign or accept a settlement

• Ask for and get all lien and payoff letters in writing.
• Confirm whether any provider has a recorded or statutory lien in North Dakota or only a contractual assignment.
• Contact government payors (Medicaid/Medicare) early and follow their reimbursement procedures.
• Consider using an escrowed settlement or court approval to avoid later claims against you personally.
• Have any release language list payments required to clear medical liens and subrogation so you don’t remain personally liable.

For general information about North Dakota statutes and court procedures, see the North Dakota Legislature site: https://www.legis.nd.gov/. For state Medicaid questions or claims contact the North Dakota Department of Human Services: https://www.nd.gov/dhs.

Helpful Hints

• Do not sign a final settlement until you obtain written payoff amounts from all known medical providers and insurers.
• If you have Medicaid or Medicare, notify them early. Failing to do so can create later repayment demands.
• Ask providers in writing whether they have an actual lien, an assignment, or only a normal billing claim. That distinction matters.
• Negotiate aggressively. Most private providers will take less than billed charges to get immediate payment.
• Use your attorney to get lien releases and written satisfactions after payoffs. Keep those documents forever.
• If you represent yourself, consider court-supervised disbursement or a neutral escrow agent to avoid personal liability from overlooked claims.
• Keep detailed records: demand letters, payoff statements, settlement drafts, and releases. These help defend against later collection attempts.
• When in doubt, consult a licensed North Dakota attorney experienced in personal injury settlements and lien resolution.