Should you go to a doctor your personal injury lawyer sends you to and receive medical treatment on a lien?

By Daniel Amos

If you have been in an accident and you have serious physical injuries, you need to see a doctor ASAP. Maybe you have health insurance, maybe you don’t.

If you hire a personal injury lawyer and the lawyer gives you the name of a doctor to see right away, should you go to that doctor and receive your treatment on a lien basis, or should you try to see a doctor on your own health insurance plan?

And if you go to the doctor your lawyer recommends, will it help your case or hurt your personal injury case? Will it cost you more money in medical bills, or will it save you money? Will the medical treatment you receive be better or worse than the treatment you might receive from a doctor on your health insurance plan?

These are all very important questions to carefully consider.

In this article, I am going to discuss these issues, and I will really focus on whether receiving medical treatment on a lien by a doctor who you were sent to by your personal injury lawyer is a good or bad idea when you have a personal injury case in California.

What is a personal injury medical lien?

Let’s start with a short definition of what a medical lien is in a California personal injury case. When doctors provide medical services to patients “on a lien”, it means the doctor is going to wait until the end of the case to receive payment, and the payment will come directly from the recovery in the case. This article will explain what that means to you and your case, so you can decide if it’s best for you. I have a whole separate article that goes into explaining the specific details about Personal Injury Medical Liens. Please take a look at it.

Insurance companies don’t want you to treat on a lien because it’s usually better for your case

Whether you should receive medical treatment from a doctor on a lien is a billion-dollar issue. Insurance companies are against it. In fact, insurance companies have spent a fortune trying to prevent you from doing it. They have mountains of political lobbyists, high-paid lawyers, biased politicians, and so-called “medical experts” who have fought this issue in the legislature, in the public eye, and the court system, all the way up to the Supreme Court.

The insurance companies call it “disturbing” that your personal injury lawyer is allowed to help you find a doctor who will provide you with first-class medical care on a lien basis. They argue, without any evidence, that the medical bills by doctors who treat injured people on a lien basis are always “inflated” by the doctors.

The contempt insurance companies have for doctors and other health professionals who treat injured people on liens is unfortunate, but it has made the insurance industry one of the wealthiest industries in the world. The insurance companies brought in $1.28 trillion in net premiums in 2020 alone!

Ask your California personal injury lawyer about medical liens

Since I started practicing law as a personal injury lawyer in 1985 this issue of injured clients receiving medical treatment on a lien basis has been one of the most constant fights by the insurance companies because one of their primary goals is to make sure injured people receive as little money and medical treatment as possible, and to make sure the insurance companies make as much money as possible.

Unfortunately, the fight is not over, and no matter when you read this blog post, you should ask your personal injury lawyer about how this might affect your case. There may be some California personal injury lawyers who feel differently than me, and if you hire one of those lawyers you should discuss this with them. But if you are in favor of the freedom to see any doctor you want, even if it’s a doctor your personal injury lawyer recommends, I urge you to contact your California State Representative and tell them you don’t want them to take this fundamental right away from you.

For more on what it means to receive medical care on a lien basis, see my blog post on understanding personal injury medical liens in California.

Injured people love the freedom of choice that medical liens can provide

If you have been injured in an accident, your primary focus is to get the best medical treatment you possibly can, as soon as you can, so you can feel better and get back to your normal healthy life. The last thing you need is the delays and hassle that come along with trying to get a medical appointment and deal with your health insurance company, if you even have health insurance. Approximately 30 million in the United States have no health insurance.

If you do have health insurance, you know how confusing and difficult it can be to deal with your health insurance company. Here are just a few reasons why receiving your medical treatment by a doctor on a lien basis might make the most sense for your health, as well as for your personal injury case:

You’ll receive better medical care

When you are injured you need to find the best doctor you can. That might even mean seeing a specialist. Depending on who your health insurance company is, you may not have access to the best doctors or to specialists. You may be limited just to the doctors who are “in your network”. And you may never get to see a specialist.

Why should your health insurance company be able to limit who you see when you need treatment for injuries caused by an accident? They shouldn’t. You should have the choice and freedom to see any doctor you choose. If you treat with a doctor on a lien, you can see whoever you want.

You’ll get treated faster and with less hassle

When you are injured, you need a great doctor ASAP. When you deal with your health insurance company you often have to get pre-approval from them to see a specialist like an orthopedic doctor, or to get a diagnostic test such as an MRI or CT scan which can take forever and delay your treatment.

If you are treating on a lien basis you will be able to get in and see a doctor, a specialist, a physical therapist, and/or get an MRI or other diagnostic procedure much faster than if you have to first contact your Primary Care Physician (PCP) to get pre-approval. This is important to both your health and your personal injury case, because if your treatment is delayed, or if you have a break in treatment because you are waiting to receive pre-authorization, the liability insurance company and/or their lawyer will deny your claim because you waited too long to receive treatment.

You’ll be in control of your own healthcare

Most health insurance policies place arbitrary limits on the amount of healthcare you can receive. For example, they usually limit how many physical therapy sessions you can have. For example, many of my former clients who had Blue Cross Health insurance only got 12 physical therapy sessions, but their doctors usually wanted them to go to more sessions because they had not yet recovered.

If you are treating on a personal injury medical lien, you can receive as many therapy sessions as you need. No one can tell you how much medical treatment you should get. When you treat on a lien you are in control of your own medical care, without the restrictions put on you by your health insurance company.

You might find it more affordable

If you are one of the 30 million people in this country without health insurance you don’t have any choice and you have to find a doctor who will treat you on a lien basis. Otherwise, you won’t have access to the medical care you need to make a full recovery from your injuries.

If you do have health insurance, but you can’t afford to make the co-payments needed to see your health insurance doctors and medical providers, you also need to find a doctor who will treat you on a lien basis.

You will ultimately pay your bills no matter what you decide, so get the best treatment you can find

No matter how your medical bills are initially paid, in any of these three examples, you will still eventually be the one who pays your bills.

If you treat on a lien basis, your doctor and medical providers will receive their payment directly out of the settlement in your case.

If you treat with the doctors and medical providers who your health insurance company has paid, your health insurance company is still going to assert a lien on your personal injury case just like the doctor on a lien, and they will also get their money from you at the end of your case.

The bottom line is, you are going to pay your bills, so you should get the best medical treatment you can find.

Here is the most recent news in the battle for your medical treatment

As of the writing of this blog post, the battle between injured people and big insurance companies continues. The most recent case to come down on this issue (August 16, 2021) was by the California Court of Appeals for the Second District in Qaadir v. Ubaldo Gurrola Figueroa et al. California Supreme Court denied a petition for review in November 2021.

In that case, Mr. Qaadir was rear-ended by a tractor-trailer truck that weighed 33,000 pounds and was traveling 45 mph. He was badly injured and needed several surgeries. His medical bills were over $800,000.

The lawyers who represented the insurance company for the tractor-trailer argued that Mr. Qaadir should not be able to collect his medical expenses. They claimed his medical bills were inflated, and that the medical treatment by his doctors was not reasonable or necessary.

Fortunately, the court ruled in favor of Mr. Qaadir and held his medical bills on a lien basis could be presented into evidence and shown to the jury to prove the reasonable value of his past medical damages at trial.

The ruling made common sense; all that Mr. Qaadir, and any injured person is asking for, is to allow the jury to see their medical records and to let the jury decide if they are reasonable or not. The lawyers for the insurance company did not want the jury to even see or hear about the medical bills, they just wanted the court to exclude Mr. Qaadir from collecting.

Insurance company lawyers argue that injured people should be forced to see whatever doctor is provided by their health insurance company, even if those doctors are not as qualified as the doctors that treat injured people on a lien. According to lawyers for the insurance companies, any bill from a doctor on a lien is inflated and bogus. That is simply not true.

Fortunately as of now, the courts have said that’s not true, and injured people are being allowed to seek the medical care they need.

Here’s what your strategy should be

​​You need to take care of yourself. Your health insurance company is not going to look out for you. The insurance company for the person who caused your injury is not going to look out for you. Your personal injury lawyer should be looking out for you and should try to find you the very best medical care available on a lien basis, so ask questions and be a good consumer advocate for yourself.

In the end, you will be paying your medical bills, so be a smart consumer and ask how much you are being charged. Ask the doctors, ask the physical therapists, ask the MRI center. If you think the bill is inflated or too high, say something. Ask for an explanation.

It’s amazing how afraid people are to ask how much they are being charged for their medical treatment. Could you imagine buying a car and not asking how much it is?

Purchasing your medical care is a lot more important than purchasing your car, and is often just as expensive! If you don’t feel comfortable asking your medical providers how much you are being charged while you are at your appointment, then send them an email and ask them. It’s less confrontational and you’ll also have their answer in writing. The bottom line, be a good consumer of your medical care.

Here’s the rest of the story

If you have gotten this far in this blog post you may be sensing my bias! I strongly believe injured people should be able to choose their own doctors and receive as much medical care as they and their physicians feel they need. Decisions about medical care should be left to doctors and their patients, not to insurance companies or their lawyers.

I know there have been some instances of abuse and fraud in the use of medical liens, but those are few and far between when compared to the vast number of patients who use the system in a legitimate way. You won’t be a victim of abuse if you choose your California personal injury lawyer wisely and you are a conscientious consumer of your medical care.

Since the development of medical liens by doctors, a whole new industry has been born. There are now financing companies that buy liens from doctors before your personal injury case is even finished. In other words, when a doctor or MRI or surgery facility agrees to treat an injured person in a lien, it means they have to wait to receive their payment until the injured person's case is over. If they don’t want to wait, they can get paid early by ‘selling’ their interest in the case (your lien) to a finance company that charges them interest.

Some have argued this is unethical and should not be allowed. It's a complicated issue and there are a lot of questions that need to be asked.

What are the professional and legal obligations of doctors?

According to the Principles of Medical Ethics of the American Medical Association (AMA), “physicians must recognize a responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.” The first AMA Principle of Medical Ethics states: “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” The sixth principle states that “physicians shall be free to choose whom to serve (except in emergencies), with whom to associate, and the environment in which to provide medical care”. The final principle requires physicians to support access to medical care for all people.

There is more to all of this than can be set forth in detail in a single blog article, but in a nutshell, lien arrangements in personal injury cases, and with treating doctors and medical facilities, when utilized properly and in accordance with California law do not violate medical ethics rules.

But big business and the insurance industry won’t give up

Despite being both legal and legitimate, insurance defense lawyers and liability insurance companies are still against these doctor-patient lien arrangements and make these claims:

  • They claim it drives up the cost of litigation and increases the value of the injured person’s personal injury case,
  • They claim it makes personal injury cases more expensive to settle, and
  • They claim it makes the doctors biased because the doctor has a financial interest in the outcome of the case.

I hope this article has provided you with both sides of the argument on California personal injury medical liens, and I hope my tips have been helpful.

If you have a specific question that I might be able to help with, or if you need a referral to a great personal injury lawyer, write to me and I will personally respond to you. Higher Legal

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Thanks for reading!

Daniel AmosAttorney since 1985Founder of Higher Legal