Detailed Answer — Overview and Step-by-Step Process

When you settle a personal injury claim in New Hampshire, health care providers, hospitals, insurers (including Medicaid), or other payors may claim a lien or subrogation interest against the settlement proceeds to recover the cost of medical treatment. Reducing or resolving those claims is often necessary so you can keep net settlement proceeds. This section explains the usual path to obtain an approved reduction of a medical lien and to finalize a settlement cleanly.

1. Identify all potential claimants and the legal basis for their claims

Start by creating a list of every health-care provider, hospital, ambulance company, health insurer (including Medicare/Medicaid or private ERISA plans), and any other party that might assert a claim against your recovery. Ask your attorney (or request on your own) for an itemized statement of charges, any lien or subrogation notices, and copies of insurance explanation of benefits (EOBs) that show payments already made.

2. Get written, itemized lien statements and backup

Request from each claimant an itemized bill and a written statement describing the lien: amount claimed, date(s) of service, billing codes, payments received from insurance, and any authority they assert for the lien. You will need these documents to evaluate reasonableness and to negotiate.

3. Determine what is reasonable and what has already been paid

Look for duplicative charges, charges reduced by insurance, or billing mistakes. In many negotiations, providers accept a discounted amount (often a fraction of billed charges) because uninsured or out-of-network billed amounts are higher than typical negotiated rates. If insurance already paid part, calculate the unpaid balance precisely.

4. Consider special payors: Medicare, Medicaid, and ERISA plans

Federal and state programs have specific subrogation or recovery rules. For example, Medicare has a mandatory recovery procedure and may require a conditional payment check to be made before final settlement. New Hampshire Medicaid also pursues claims for repayment from settlements. These payors often have a formal process and deadlines. Contact the payor to request a demand or conditional-payment statement early so you can account for it in settlement negotiations.

5. Negotiate in writing

Open negotiations with each claimant. Common negotiated outcomes include:

• Payment of a lump-sum reduced amount in full satisfaction of the lien.
• An agreement for a percentage of the settlement (for example, 20–40% of the recovery attributable to medical damages) in exchange for a release.
• A holdback arrangement where settlement proceeds are held in escrow until the lien is resolved.

When negotiating, present supporting evidence: total settlement amount, allocation to medical damages (if applicable), and any evidence that billed charges exceed customary rates.

6. Get a written release or lien waiver

Do not rely on oral promises. After any agreement, obtain a written release or lien waiver that says the claimant will accept a specified reduced amount as full and final satisfaction of any claim against proceeds from the particular claim and will not pursue further collection from you or the settlement. The release should be specific about the case, date of injury, and the settlement involved.

7. If a claimant refuses to negotiate, use these options

• Ask for proof of the lienholder’s legal right to assert a lien against settlement proceeds. If they cannot show a valid legal basis, you may press them to withdraw the claim.
• Offer a good-faith holdback of disputed funds in escrow, with a proposed court order allocating the funds until resolution.
• File a motion in court asking the judge to approve the settlement and to determine how proceeds should be distributed (this is common when multiple lienholders dispute allocation or when a claimant refuses to sign a waiver).

8. Court approval and distribution

In many NH cases you can settle privately and distribute funds by agreement. If a lienholder refuses to sign a release, or if the court requires approval (for example, settlements involving minors or incompetents), your attorney can file a motion asking a court to approve the settlement and the proposed distribution of proceeds. Attach supporting documents: settlement agreement, itemized lien statements, proof of negotiations, and a proposed order directing how the net settlement will be disbursed. The court can then enter an order approving a reduced payment to the claimant and directing distribution of the remaining funds to you.

9. Close the settlement and keep careful records

After you pay the negotiated amounts and obtain releases, keep originals of all waiver/release documents, cancellation of liens (if recorded), and final accounting of disbursements. If a lienholder seeks further payment later, you will have the release to defend against the claim.

Typical timeline

Early contact with all claimants reduces delay. Expect negotiations to take a few weeks to a couple of months, longer if Medicare/Medicaid conditional payment processes apply or if a court hearing is needed.

When to involve an attorney

Hire an attorney if any of these apply: multiple or large lien claims, Medicare/Medicaid subrogation, ERISA-plan recovery demands, the claimant refuses to negotiate, or a court needs to approve the settlement. An attorney experienced in New Hampshire personal injury settlements will prepare the paperwork, negotiate with lienholders, and (if needed) petition the court to approve reduced payoffs and distribution of settlement funds.

Example of the process (hypothetical)

Fact pattern: You settle a car-crash case for $50,000. A hospital claims a $32,000 billed balance; insurance paid $10,000, leaving $22,000. You negotiate and document: the hospital accepts $7,500 in full satisfaction, signs a written release specific to the case, and records no further claims. The settlement pro se or through counsel provides net proceeds after attorney fees and creditor payments. A signed release prevents future collection.

Key documents you should obtain

• Itemized bills and EOBs
• Written lien demand or subrogation statement
• Written settlement offer and any response
• Settlement agreement and closing statement showing allocation
• Signed lien release or satisfaction document
• Court order approving settlement and distribution (if applicable)

Important disclaimer: This article provides general information about how medical liens are often resolved in New Hampshire personal injury settlements. It is not legal advice. Laws and procedures can change, and facts matter. Consult a licensed New Hampshire attorney to handle your specific situation.

Helpful Hints — Practical Tips to Improve Your Chances of a Reduction

• Start early. Request lien statements as soon as liability and settlement value look likely.
• Keep good records of all medical payments, insurance EOBs, and communications with providers.
• Request itemized bills and challenge obvious billing errors or duplicate charges.
• Ask for a written demand that specifies the legal basis for the lien and any statute or contract claimed.
• When negotiating, offer a reasoned, documented counter-offer rather than a lowball number; providers often expect negotiation and accept discounts.
• If Medicare or Medicaid may have paid, notify them immediately to obtain a conditional payment figure; failing to do so can create penalties or offset reductions later.
• Use escrow or a holdback for disputed liens when necessary. That protects you from future claims while keeping settlement moving forward.
• Get everything in writing: settlement allocations, releases, and lien waivers must be explicit and case-specific.
• Consider hiring counsel if multiple claimants, government payors, or large sums are at stake; attorney involvement often gets faster, larger reductions.

For authoritative information about New Hampshire laws, forms, or court procedures visit the New Hampshire Judicial Branch website (https://www.courts.state.nh.us) or consult a New Hampshire-licensed attorney.