How Medical Bills Are Handled During an Injury Case

Getting hurt in an accident is stressful enough on its own.

Then come the medical bills in the mail. Emergency room, X-rays, physical therapy, follow up appointments …they really add up fast.

The thing most folks don’t understand is how those bills are paid in an injury case. It’s very different than your typical doctor’s visit. Liens, subrogation language, negotiating…LOTS of pieces to keep track of.

This guide breaks down exactly how it works — in plain English.

Who Pays Medical Bills While the Case Is Open?

Injury cases can take months. Sometimes years.

However medical bills don’t take a vacation. Providers still expect to get paid … even while an attorney negotiates with the at-fault party’s insurance company.

So who pays in the meantime?

There are usually a few options:

• Health insurance covers the bills upfront
• The at-fault party’s insurance pays through a settlement later
• Out-of-pocket payments that get reimbursed at settlement
• A medical lien lets doctors treat now and get paid later

Every choice has different rules governing it. And which choice gets exercised can dramatically impact the overall margins achieved in a case.

What Is a Medical Lien?

A medical lien is basically a legal IOU.

The doctor or hospital agrees to provide treatment to the patient now. In exchange, the patient signs a lien stating the provider will be paid from the settlement when the case concludes.

This means a lot for the uninsured. Without lien capabilities they would avoid treatment all together – or incur bills they cannot afford.

Here’s how the lien process typically works:

1. Treatment happens after the accident
2. The provider files a lien with the attorney
3. The case settles or goes to trial
4. The lien is paid straight out of the settlement funds
5. Whatever is left over goes to the injured person

But here’s the catch:

If the case is lost, the lien doesn’t go away. The injured person still owes the full amount.

Slip and Fall Injuries and Medical Bill Complications

Slip and fall accidents are one of the easiest ways to accumulate massive medical expenses quickly.

Car accidents, broken bones, back injuries, concussions… slip and fall accidents are no joke. Slip and fall accidents account for roughly $70 billion in medical expenses and workers compensation costs nationwide every year.

And there’s more. The average hospital bill from a slip and fall is over $30,000 — not including physical therapy and any long-term follow-up treatment.

Should someone have been injured due to a slip and fall at another person’s property, contacting an experienced Houston personal injury lawyer could help determine who will be held legally responsible for those expenses. Homeowners are required to ensure their property is safe for visitors — and when they don’t meet that obligation, they can be responsible for the medical bills that resulted from their negligence.

The bills from a slip and fall usually stack up in three main categories:

• Emergency care: ER visit, imaging, initial treatment
• Ongoing treatment: Physical therapy, surgery, follow-ups
• Long-term care: Chronic pain management, future procedures

Everything needs to be documented properly. Lawyers use those documents to prepare the case and prove exactly how much is owed.

How Health Insurance Fits In

One misconception people have is that if they have insurance, the insurance company will just… pay for everything. Sure?

Not quite.

Health insurance will typically pay for treatment up front. However they also have a legal right known as subrogation — the ability to demand repayment from the settlement.

Here’s why:

If the health insurer covers the cost of medical care and the injured person subsequently recovers from the at-fault party for those bills, they would be paid twice. Subrogation prevents that “double dip.”

It’s not always fair-feeling… but it is the way the system works.

Medicare and Medicaid have lien rules that are basically the same. If either Medicare or Medicaid covered treatment, they will be reimbursed out of the settlement as well. These liens cannot be avoided either, the penalties are very high.

Negotiating Bills Down at Settlement

Now the good part.

Medical bills and liens aren’t always firm. Often a good personal injury lawyer can negotiate them down — sometimes significantly.

For example, let’s say that all the medical bills add up to $100,000. The attorney negotiates with the hospital and convinces them to reduce their lien to $70,000. That means that $30,000 that would have gone to the hospital remains in the hands of the injured party.

So why do providers accept less? A few reasons:

• They would rather get paid something than chase collections
• They know the settlement pool is finite
• They value keeping good relationships with law firms
• Some state laws limit what they can collect

Negotiation is one of the least understood phases of an injury case. It can DOUBLE the take home money.

What Actually Lands in Your Pocket

Here is the final breakdown of how a settlement usually gets divided up:

1. Attorney fees come out first (usually a percentage)
2. Case expenses are deducted
3. Medical liens and subrogation claims are paid
4. Whatever remains goes to the injured person

The last figure there is for pain and suffering, lost wages and future medical treatment.

Large medical liens reduce the final payout. Negotiating them down is so important because of that.

Final Thoughts

Medical bills can be daunting when first encountered in an injury case. Once the way liens, subrogation, negotiation and settlements all work makes sense, it’s pretty simple.

To quickly recap:

• Medical bills don’t pause and wait for the case to settle
• Liens let the injured person get treated now and pay later from the settlement
• Health insurance can seek repayment through subrogation
• A slip and fall injury can trigger huge, complicated bills
• Attorneys can usually negotiate liens down to a lower amount
• The final take-home amount depends on how well those bills get handled

The long and short of it? Trying to tackle the medical bill aspect of an injury claim alone is never wise. Dealing with the paperwork, negotiations and statutes of limitations … it’s simply too much for one person to handle on top of recovering from injuries.

Get a good lawyer. Focus on getting better. Let them handle the rest.