Disclaimer: This article is for informational purposes and does not constitute legal advice. Consult a qualified attorney for advice specific to your situation.
Detailed Answer
In North Dakota, if you receive a personal injury settlement, you generally must satisfy valid medical liens before you keep the balance. Medical liens allow hospitals, doctors, and certain other providers to claim a portion of your settlement to cover the cost of care they provided for your injury.
1. Hospital and Provider Liens under NDCC Chapter 32-18
Under North Dakota Century Code §32-18-01, a hospital or physician who treats an injured person can file a lien against the claim, judgment, or settlement to secure payment for services rendered. Once properly filed, the lien:
- Attaches to any settlement, judgment, or arbitration award related to the injury.
- Must be paid out of the recovery before disbursing funds to the injured party. See NDCC §32-18-01 and NDCC §32-18-03 (determining lien amount).
- Survives even if the plaintiff changes counsel or settles quietly.
If you fail to satisfy a valid lien within the deadline (often 60 days after demand), the provider may enforce the lien by suing you or recording a foreclosure action.
2. Health Insurer and Subrogation Rights
Private health insurers or third-party administrators may have subrogation or reimbursement rights if they paid your medical bills. While North Dakota has no specific statute governing all subrogation claims, most insurers rely on contractual language and equitable subrogation. Their right to reimbursement generally arises from:
- Your health plan’s policy language requiring repayment from settlements.
- Equitable principles allowing the insurer to step into your shoes and collect from the at-fault party.
You can often negotiate these liens down, especially if you contributed to your treatment costs or your attorney handles negotiations.
3. Government and Medicare/Medicaid Liens
If Medicare or Medicaid paid your medical bills, federal and state law require repayment from your settlement. Key laws include:
- Federal Medicare Secondary Payer Act (42 U.S.C. §1395y(b)(2)): Medicare must be reimbursed from third-party recoveries. 42 U.S.C. §1395y.
- North Dakota Medicaid Recovery, NDCC §50-24.1-52: State Medicaid has a right to recover from any settlement for services paid on your behalf. NDCC Chapter 50-24.1 (see §50-24.1-52).
4. Practical Steps When You Settle
- Request an itemized statement of liens from each medical provider or insurer.
- Review and challenge any amounts that appear excessive or unrelated to your injury.
- Hold settlement funds in your attorney’s trust account until liens are resolved.
- Negotiate reductions where possible—many providers will accept less than the full billed amount.
- Obtain lien release documents before disbursing funds.
Helpful Hints
- Keep detailed records of all medical treatment and payments.
- Notify each provider of your pending settlement and request a written lien statement early.
- Ask your attorney to include lien resolution language in your settlement agreement.
- Consider mediation for lien disputes to avoid costly litigation.
- Always verify statutes and deadlines: statutory lien claims often have strict filing and repayment time frames.