Dog Bite Medical Lien Lawyer in Los Angeles, CA Hospital, Plan and Medi-Cal Limits

The hospital lien, and what it attaches to

Civil Code section 3045.1 gives a hospital licensed under the laws of this state, which furnishes emergency and ongoing medical or other services to a person injured by reason of an accident or a negligent or other wrongful act not covered by the workers' compensation divisions of the Labor Code, a lien upon the damages recovered or to be recovered by that person, to the extent of the reasonable and necessary charges of the hospital and any affiliated health facility for treatment, care and maintenance resulting from that act. Two limits sit inside that sentence: the charges must be reasonable and necessary, and the lien attaches to the recovery rather than to the patient generally.

The fifty percent ceiling on hospital liens

The enforcement provision numbered 3045.4 in the Civil Code addresses what happens when a payer, including an insurance carrier, pays the injured person or that person's attorney after receiving the notice described in section 3045.3 without paying the hospital. Liability runs to the amount of the lien claimed in the notice, or so much of it as can be satisfied out of 50 percent of the moneys due under any final judgment, compromise or settlement agreement after paying any prior liens. That percentage is the practical ceiling that keeps an emergency-department charge from consuming an entire recovery.

Health plan liens are capped differently, and reduced twice

Civil Code section 3040 governs liens asserted by licensees of the Department of Managed Health Care or the Department of Insurance, and by medical groups and independent practice associations, for money paid on behalf of an enrollee or insured. Such a lien may not exceed the sum of the reasonable costs actually paid to perfect it plus, for services not provided on a capitated basis, the amount actually paid to treating providers, or for capitated services, an amount equal to 80 percent of the usual and customary charge for the same services in the geographic region. Subdivision (c) adds that where the enrollee engaged an attorney, the lien may not exceed the lesser of that maximum or one-third of the moneys due under any final judgment, compromise or settlement agreement, and subdivision (d) sets the comparable figure at one-half where no attorney was engaged. Subdivision (e) requires the lien to be reduced by the same comparative fault percentage by which the recovery was reduced where a judge, jury or arbitrator makes a special finding of partial fault, and subdivision (f) subjects it to pro rata reduction commensurate with reasonable attorney's fees and costs under the common fund doctrine.

What section 3040 does not touch

Subdivision (g) excludes three categories from its limits: a lien made against a workers' compensation claim, a lien for Medi-Cal benefits under the Welfare and Institutions Code article beginning at section 14124.70, and a lien for hospital services under the chapter beginning at Civil Code section 3045.1. Those three are governed by their own provisions, which is why a single sentence about liens is usually wrong.

The Medi-Cal limit

For Medi-Cal, Welfare and Institutions Code section 14124.78 provides that in no event shall the director recover more than the beneficiary recovers after deducting, from the settlement, judgment or award, attorney's fees and litigation costs paid for by the beneficiary, and that where recovery is determined under that section the reductions in subdivision (d) of section 14124.72 do not apply. The comparison is made after fees and costs, not before.

Where a work injury changes the order

If the bite happened on the job, a compensation carrier's interest is handled inside the third-party recovery. Labor Code section 3856 provides that where the employee prosecutes the action alone, the court first orders paid from the judgment the reasonable litigation expenses and a reasonable attorney's fee based solely on services rendered in effecting recovery for both employee and employer, and then, on the employer's application, allows as a first lien the employer's expenditure for compensation together with amounts to which the employer may be entitled as special damages under section 3852. Section 3852 preserves the injured worker's claim against the third party while allowing the employer its own claim.

Why the treatment record still governs the number

Every one of these provisions measures a share of something. The something is the recovery, and the recovery is measured under Civil Code section 3333 as all the detriment proximately caused, whether or not it could have been anticipated. Where multiple parties share fault, Civil Code section 1431.2 makes non-economic damages several only in proportion to each defendant's fault, which affects the size of the pool from which every lien is later calculated.

A minor's recovery is held, not handed over

Where the injured person is a child, Probate Code section 3611 lists the ways the balance may be held after fees, costs and liens: delivery to a guardian or conservator of the estate, deposit in an insured account or a single-premium deferred annuity subject to withdrawal only on court authorization, a special needs trust under section 3604 after a hearing, other conditions where the balance does not exceed twenty thousand dollars, or payment to a parent without bond where it does not exceed five thousand dollars.

Practical steps

Ask each provider in writing whether a lien has been asserted and under which statute. Keep the itemized statements rather than balance letters. Note the dates any lien notice was received.

Scope

General information about California lien statutes, not legal advice about any bill or recovery. Specific questions belong with the attorney who advertises on this site.