Short answer
Yes. In West Virginia, medical providers—including hospitals, doctors, and chiropractors—and health insurers can often seek payment (by lien, subrogation, or reimbursement) out of a personal-injury settlement. Federal programs (Medicare and Medicaid) and private health plans usually have legal rights to be repaid from any recovery you obtain for the injury that generated the medical bills.
Disclaimer
This is general information only and not legal advice. I am not a lawyer. For advice specific to your case and to protect your rights, consult a licensed West Virginia attorney experienced with personal injury, medical provider liens, and insurance subrogation.
Detailed answer — how medical and chiropractor liens can affect your West Virginia settlement
What kinds of claims can reduce your settlement?
- Provider liens or charging liens: Some medical providers (including chiropractors) use written agreements or statutory/contractual rights to assert a lien on any recovery you get from a third party. A lien gives the provider a claim against settlement proceeds until their bill is paid.
- Health insurer subrogation/reimbursement: If an insurer (private ERISA plan or other health insurer) paid your medical bills, the insurer may have a contractual or legal right to be reimbursed from your recovery.
- Medicare and Medicaid: Federal law requires Medicare and state Medicaid programs to be repaid from third‑party recoveries when those programs paid for treatment. See the Medicare secondary payer rules (42 U.S.C. § 1395y(b)) and federal Medicaid third‑party liability and recovery rules (42 U.S.C. §§ 1396a(a)(25), 1396k). For Medicare information from CMS: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Medicare-Secondary-Payer
- Judgments and court-ordered liens: If a provider sues you (or sues the tortfeasor) and obtains a judgment, that judgment can become a lien enforceable against settlement funds.
How the process usually works
When you reach a settlement with the at-fault party or their insurer, settlement funds flow through a settlement statement and distribution process. Before you get a check, parties with legal claims against the settlement commonly demand payoffs. Typical order of events:
- Your lawyer requests payoff letters from medical providers, insurers, Medicare/Medicaid, and any lienholders.
- Those entities provide payoff figures or statements of their asserted lien amount.
- Your lawyer negotiates reductions where possible and prepares a settlement allocation that separates damages (pain and suffering, lost wages, medical bills, future medical care).
- Funds are distributed after liens, attorney fees, and other allowable costs are resolved.
Special rules that commonly apply in West Virginia cases
West Virginia plaintiffs typically face the same three practical categories of claims against settlement proceeds:
- Private provider liens or agreements: A chiropractor who treated you may have a written agreement giving them a lien on a recovery. If so, they can demand payment or sue to assert that lien.
- Insurer subrogation (including ERISA plans): ERISA and other private plans can assert contractual subrogation rights. ERISA plans often have strong enforcement mechanisms; see the federal ERISA enforcement statute (29 U.S.C. § 1132). A plan may assert a portion of your recovery to reimburse medical payments they made on your behalf.
- Government payors (Medicare/Medicaid): Medicare is entitled to conditional payment recovery and must be reimbursed from settlements. Medicaid also has a right to recovery. Federal law requires these programs be repaid prior to your final distribution; failure to resolve these claims can delay or jeopardize distribution. Useful federal resources: Medicare MSP (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Medicare-Secondary-Payer) and the Medicaid recovery rules at 42 U.S.C. §§ 1396a(a)(25) and 1396k (see https://www.govinfo.gov).
Can you prevent liens from being deducted?
Not always. You may be able to reduce or eliminate some claims through negotiation, documentation, or legal defenses. Common options include:
- Negotiate a discounted payoff from a provider (many hospitals and providers accept less than billed amounts to resolve quickly).
- Ask insurers or plans for a written subrogation settlement or lien waiver in exchange for a reduced payment.
- Allocate part of the settlement to non‑medical damages (pain and suffering), which insurers and payors cannot always reach depending on the terms of their subrogation rights and applicable law.
- Hire counsel experienced in lien resolution—attorneys routinely reduce payoffs and resolve government liens so claimants receive net recovery.
What to do now — practical steps
- Ask for a written itemized statement from each medical provider and your chiropractor.
- Request written payoff letters from any provider, insurer, or government payor claiming a lien or reimbursement right.
- Tell your personal‑injury attorney about every insurer or plan that paid your bills (private insurance, auto PIP, Medicare/Medicaid, workers’ comp, etc.).
- Don’t sign the final settlement or accept funds until all lien and subrogation issues are addressed in writing.
- Work with counsel to negotiate reductions and obtain lien waivers or release language in the settlement documents.
Where to get help and useful West Virginia resources
- West Virginia Department of Health and Human Resources, Bureau for Medical Services (Medicaid): https://dhhr.wv.gov/bms/Pages/default.aspx
- West Virginia Code (statutes and searching state law): https://code.wvlegislature.gov/
- Medicare Secondary Payer (CMS): https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Medicare-Secondary-Payer
- Federal statutes on Medicare/Medicaid and ERISA enforcement (see U.S. Code at govinfo for the exact text): https://www.govinfo.gov
Bottom line
Yes—medical and chiropractor liens and insurer/government reimbursement claims commonly reduce settlement funds in West Virginia. The exact amount depends on whether the provider or insurer has a valid lien or subrogation right, whether the lien can be negotiated down, and whether Medicare or Medicaid repayment rules apply. The safest course is to work with an attorney who will obtain payoff letters, negotiate reductions, and secure written lien waivers so you know what net recovery you will receive.
Helpful Hints
- Get every payoff figure in writing before you sign a settlement.
- Ask for itemized bills to spot billing errors or duplicate charges.
- Tell your lawyer about any health programs (Medicare/Medicaid) or insurers that paid your bills—government payors often require advance notice and conditional payment resolution.
- Request a reduction in writing; many providers accept less than their billed amount in exchange for quick resolution.
- Consider allocating part of the settlement to future medical expenses—this can affect subrogation and tax treatment.
- Don’t pay anything to a claimant or sign releases until all lien claims and subrogation issues are resolved in writing.