Will medical or chiropractor liens be deducted from my Tennessee settlement?

Short answer: Possibly. Some medical providers and some payors can claim a portion of your settlement in Tennessee, but which entities can attach a lien, how much they can demand, and when the money is deducted depend on the type of provider, whether a statutory lien applies, any insurer or government subrogation rights, and whether liens are perfected or negotiated before distribution.

How liens and reimbursement claims commonly arise after an injury

After a car crash or other injury you often face three separate sources of claims against any settlement money:

• Provider claims (hospitals, physicians, chiropractors) for unpaid treatment charges.
• Insurer subrogation or contractual reimbursement claims (your health insurer or auto insurer that paid bills).
• Government payors (Medicaid/TennCare, Medicare) with mandatory repayment or lien rights.

Which Tennessee statutes and government programs matter

State and federal rules can give different entities a right to be repaid:

• Hospital and facility liens: Tennessee recognizes hospital/facility lien laws that allow certain treatment facilities to claim against an injured person’s recovery. For authoritative Tennessee statutes and full text of state law, see the Tennessee Code hosted by the Tennessee General Assembly: https://www.capitol.tn.gov/. Search for the Hospital Lien Act (hospital/facility lien provisions are contained in state code sections governing liens).
• TennCare (Medicaid) and state recovery: Tennessee’s Medicaid program (TennCare) asserts third‑party liability and recovery rights. For TennCare third‑party liability information see: https://www.tn.gov/tenncare/.
• Medicare: Federal law (Medicare Secondary Payer rules) allows Medicare to seek reimbursement for conditional payments related to the injury. See CMS for Medicare repayment guidance: https://www.cms.gov/.

Do chiropractors have an automatic statutory lien in Tennessee?

Generally, chiropractors in Tennessee do not have the same automatic statutory hospital lien that hospitals and certain licensed facilities possess. A chiropractor’s ability to take money from your settlement depends on whether the chiropractor or provider has:

• a written assignment or contract with you that grants a right to be paid from any recovery;
• filed a valid lien under a statute that expressly covers that type of provider (more common for hospitals and certain inpatient facilities); or
• obtained a judgment against you and then enforced that judgment against your assets (including proceeds in some cases).

Because chiropractors often rely on contracts and negotiated agreements rather than a statutory lien, many chiropractor claims are handled as private debts that can be negotiated or litigated rather than automatically deducted by the settling insurer or opposing party.

What about hospitals and emergency facilities?

Hospitals and certain licensed facilities are more likely to have a statutory lien right in Tennessee. If a hospital properly perfects a lien under Tennessee law, the hospital can seek payment from your settlement proceeds. That means hospital charges are often deducted (or at least asserted) before you get the final net recovery.

Insurance subrogation and contractual reimbursement

Your health insurer or auto insurer may have subrogation or contractual reimbursement rights. If your insurer paid medical bills, it may demand repayment from your settlement. These claims can be enforced by letter, by filing a lien or lawsuit, or by withholding by an insurer that issues the settlement check. The exact enforceability often depends on the insurer’s policy language and state law governing subrogation and equitable allocation.

Medicare and TennCare (Medicaid) recovery

Federal and state programs have strong repayment rights:

• Medicare (federal) will typically seek reimbursement for conditional payments related to the injury under the Medicare Secondary Payer rules. You must notify Medicare of settlements and resolve conditional payment claims before you finalize distribution of funds. See CMS guidance: https://www.cms.gov/.
• TennCare (Tennessee Medicaid) has third‑party liability and recovery claims. TennCare may assert a claim against your settlement and require repayment for services it paid. See TennCare: https://www.tn.gov/tenncare/.

Typical order of payment when a settlement is distributed

While distribution order can vary by case and any court order, a common sequence is:

1. Attorney fees and litigation costs (per your contingent fee agreement).
2. Payments to lienholders and creditors who have valid, perfected claims (medical liens, hospital liens, government repayments, valid subrogation claims).
3. Remaining net recovery to the client.

Because lien resolution often happens before final distribution, it is crucial to identify and address all potential liens before signing settlement documents or cashing checks.

Example (hypothetical)

Imagine a $50,000 settlement after a Tennessee car wreck. Bills and claims include:

• Hospital bill: $10,000, with a perfected hospital lien.
• Chiropractor: $3,000 billed; no statutory lien but a treatment contract and an unpaid balance.
• Health insurer (TennCare or private): paid $6,000 and asserts subrogation.

After attorney fees and negotiated reductions, you might end up paying a negotiated portion of the hospital lien, a negotiated payoff to the chiropractor (often less than the billed amount), and negotiated reimbursement to the insurer. Final numbers depend on negotiation, statutory priorities, and whether government payors require full repayment.

What you should do now (practical steps)

• Tell your attorney about every medical provider and every insurer that paid bills for your injury.
• Ask your attorney to obtain lien payoff letters and to confirm whether any liens were properly perfected under Tennessee law before settlement.
• Do not cash settlement checks until liens and subrogation claims are resolved or the court/ insurer authorizes distribution.
• Ask your attorney to negotiate reductions. Many providers accept less than full billed amounts in exchange for prompt payment from settlement proceeds.
• If TennCare or Medicare may have paid, ensure your attorney handles required notices and repays the programs as required to avoid later demand or liens.
• Request written releases from each lienholder showing that they release claims against the settlement after payment.

Helpful links and places to check

• Tennessee Code and statutes (official): https://www.capitol.tn.gov/
• TennCare (Tennessee Medicaid) third‑party liability information: https://www.tn.gov/tenncare/
• Centers for Medicare & Medicaid Services (Medicare recovery/MSP): https://www.cms.gov/

Helpful Hints

• Get a full lien report early. Your attorney should request payoff statements from every medical provider and any insurer that paid your bills.
• Negotiate aggressively. Many medical providers and insurers accept reduced payoffs from settlement proceeds.
• Keep settlement funds in trust until liens are resolved. This protects you from claims the payor may later assert.
• Obtain written releases. Never let the insurer or opposing party distribute funds until you have releases showing liens are satisfied.
• Be proactive with government payors. Medicare and TennCare have procedures and deadlines; missing them can create future personal liability.
• Ask for itemized bills and verify charges. Mistakes and duplicate billing are common and give room to negotiate down balances.

When to talk to an attorney

If you have multiple medical bills, a government payor involved (Medicare or TennCare), or providers threatening lawsuits or liens, talk with an experienced Tennessee personal-injury attorney before you accept or cash any settlement funds. An attorney can help identify which claims are valid, negotiate reductions, and ensure distribution follows applicable law and your fee agreement.