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Carrie: Hello everyone and welcome to the Schultz & Myers Personal Injury Lawyers Injury Law Firm Podcast for May 15th, 2015. My name is Carrie and I am joined today by St. Louis injury lawyer, and founding partner of Schultz & Myers Personal Injury Lawyers, Stephen Schultz. Welcome, Stephen.

Stephen: Thanks Carrie, happy to be here!

Carrie: Stephen is a personal injury attorney in St. Louis, but you also practice throughout all of Missouri, and also Illinois and Arkansas, correct?

Stephen: Absolutely

Carrie: Stephen, today you wanted to bring to light some of the lesser-known facts about the Missouri Lien statutes.

Stephen: That’s right. Part of the 5 star service my firm provides is getting clients the medical treatment they need after being involved in injury due to somebody else’s negligence. 

Carrie: Like, for example in a car accident?

Stephen: Exactly. I get several phone calls a week about car accidents. It is the most common type of claim that we handle at Schultz & Myers Personal Injury Lawyers. Somebody is driving along and then bang, they’re hit from the side or behind, or you’re broadsided. The injuries can range from very minute to serious. Some even require surgery. Some are even calling on behalf of loved ones who were fatally injured in an accident. When that person calls needing help in pursuing a claim through the driver’s insurance company, the first thing we need to do is inquire as to whether or not they need medical treatment. 

Carrie: Like if they need physical therapy or a follow up with a GP?

Stephen: Sure, but it can be more than that. in any personal injury case it can be important to not only get the treatment, but get it from providers that are specialists, and who will advocate for you in front of an insurance company. This can include physical therapy, pain management, and even chiropractic care. Sometimes it can even require surgery. 

Carrie: Sure, but how would somebody pay for that? What if they’re hurt, but don’t have health insurance?

Stephen: That’s a good question. If you hire an attorney – a good attorney – who practices solely in that area, you should have the option to receive that treatment on what’s called a “lien”

Carrie: Okay, sure, but what is a lien? What does that mean?

Stephen: A lien is essentially a legal claim for a portion of an asset. So if a doctor treats a person on a lien, it means he or she has agreed to treat that person and defer the bill. Essentially they wait to get paid until the personal injury claim is settled or resolved. After their personal injury attorney has obtained a verdict or a settlement, we will pay that medical bill directly from the amount obtained. 

Carrie: So the injured person can get otherwise unaffordable treatment, and the doctor can still be guaranteed payment? How does that work?

 Stephen: Well it’s the law in Missouri. The Missouri Hospital Lien Statute which is 430.225 dictates that, when a person is injured and seeks compensation from the person responsible for the injury, any medical providers can assert a legal claim on the settlement to satisfy the medical bills stemming from that injury.

Carrie: So, if a doctor asserts a lien, he is guaranteed payment?

Stephen:  Yes. Uh, depending upon whether or not the doctor properly asserts the lien, but yes. When the insurance company sends a settlement check to my office, it is my job, my legal obligation at that point, to pay the doctor any type of uh balance that is owed for treatment directly related to the  uh, to the crash that we are handling the legal claim for.

Carrie: What happens to the doctors’ bills that are sent directly to the injured person?

Stephen: Well, uh, several things can happen, first of all, you know it depends on whether or not the uh, patient slash my client has health insurance so to answer that question, let’s just kind of examine it piece by piece. Um, I can speak generally that any person that who is hit in you know in a crash or injured, slip and fall whatever it may be is under a certain amount of duress, both psychologically and financially. So most of the time, sending a bill directly to a patient who is already injured and potentially not working because of that injury creates uh, even more financially duress so, sometimes they don’t pay it at all. Sometimes they try to establish some type of payment relationship or arrangement by calling the doctor. Sometimes they disregard the bill altogether. Sometimes they forward the bill actually to our office and say look Stephen, you know, you’re my lawyer, what should I do about this bill? We have an MRI bill for $2,000 bucks, we can pay it, and what do we do? And so it really depends upon the size of the bill, it depends upon, you know, who the facility is, and I always tell clients, that collection agencies can be relentless, you know the patient gets harassed, their credit score suffers. So it’s always important to make sure uh, I always recommend that my clients make sure and take care of that bill whether it be establishing a payment relationship or payment arrangement with the facility or just calling, I’ll just call the facility directly and say, ‘look Doctor, I’m handling this personal injury case for my client who is your patient. If you assert a lien with my office, that will guarantee payment out of the settlement. So that’s one financial vehicle to make sure that the providers are paid. But if you send the bill directly to the patient, uh, you know, eight times out of ten, it’s just going be sitting on a table or a kitchen counter, not getting paid.

Carrie: That all sounds like a pretty good deal for the doctors, is there a downside to asserting a lien?

Stephen:  So there, there is a down side to asserting a medical lien. You know while that does guarantee payment of some sort if there is a settlement in certain situations, that doesn’t mean that you are going to get paid a hundred percent of your bill.

Carrie:  Negotiated reductions?

Stephen:  Yes, negotiated reductions in some cases. So here’s how that works. And this is all pursuant to the medical lien statute. It’s not nothing that I’m making up. This is all statutory law. So let’s, let’s use round numbers. It’s probably easiest. If we get a settlement for a car accident for $10,000. And let’s say our attorney’s fees that we charge are a third so that’s $3300 dollars. And let’s say we had some case expenses that we had to advance to uh get the settlement so let’s say when it’s all said and done, after attorney’s fees and expenses there’s $6000 left to go around. So $6,000 remains out of that $10,000 global settlement. So what do the facilities get? What do the doctors get? Well, it depends on the amount of the bill. But the law says that out of the remaining $6,000 dollars that is left after out attorney’s fees and case costs, all of the facilities, all of the doctors who have liens or bills, will only be able to get a total of $3,000 dollars out of the $6,000. So that statute says that 50% of the remaining balance of the settlement goes to the claimant, being the patient slash client. So let’s take that a step further, let’s say that after the $10,000 dollar settlement, after the attorney’s fee and expenses there’s $6,000 left and let’s say all of the medical care totals $5,000 dollars. Well in that situation, we can’t pay everybody their full bill because again, only $3,000 is allowed to go to all of those facilities together so we actually just, we apply a pro rata share ratio which is a pretty simple formulas that we send out with our letters to these facilities. And all of these facilities have to accept uh, their pro rate share, depending on how big their bill is. Does that make sense?

Carrie: Sounds like even after taking a pro rata reduction, the providers still come out ahead?

Stephen:  Yeah, Most of the time, even after taking a pro rata reduction, the uh, medical facilities are left with a good amount of money. And here’s how I look at it. And I think the facilities will, will understand this. In certain situations, and this usually applies obviously when there is no health insurance. You know if there is health insurance, this is really a non-issue because health insurance can be paid, its guaranteed payment and there is no waiting for that. But this mainly applies when there is no health insurance. So, if we look at it from that perspective, most of the time uh, doctors and hospitals have a negotiated rate with health insurance companies which only allows for a certain percentage of the bill being paid.  Well most of the time even when applying the hospital lien statute these doctors are getting paid more out of the settlement I am able to get for them than billing than billing health insurance. So it actually works out even with reductions based upon the medical lien statute. You actually end up getting paid a good amount of money for the physician’s bill. Now in certain situations when there is a catastrophic injury and there is only a Missouri car insurance policy of $25,000 and there is catastrophic injuries, in certain situations you know it’s possible that the facilities get very little but that’s very rare, or its more rare than happening.

Carrie:  So, do all medical providers treat patients on a lien?

Stephen:  No. Not all facilities will treat patients on a lien. You know in my experience, um we’ve had good success with getting certain doctors and physical therapists an chiropractors to treat our clients on a lien because they know that we do great legal work. They know that we specialize in injury cases and car accidents. So most of these doctors are comfortable treating on of our clients on a lien because they know it’s more likely than not they are going to get paid, because we are good at getting settlements. So, to answer your question, not all facilities will treat patients on a lien because they’re not comfortable either with the lawyer handling the case or even they’re not comfortable waiting for sometimes six months to a year to get payment. So, uh some Doctors don’t but we’ve had good success with a handful of doctors and physical therapists and other facilities all across Missouri, because they know, we get them paid most of the time, if not all of the time.

Carrie: So essentially, you establish a doctor–lawyer team to achieve the most complete recovery physically speaking, but also financially.

Stephen: Exactly. You know, our goal as lawyers is to maximize our client’s financial compensation from the negligent party, but we also have an interest in protecting the doctors who treat our clients. So we have a vested interest in making sure that those doctors who give our clients great patient service and who are patient advocates, we want them to get paid too, that’s only fair, so, um, we have a mutual goal with the Doctors who treat our clients in getting them compensated and also making sure that those doctors’ bills are paid out of the settlement.

Carrie: Stephen, thank you so much for talking with us today about Missouri Hospital Lien Statute! We have just a couple questions that our listeners submitted earlier this week.

Stephen: So, here’s some more advice too, just generally for medical facilities, you know the way the medical lien statute is written, it requires the facilities the medical facilities to, uh, the way they perfect, quote unquote, perfect the lien is to send notice of the bill to the at fault party. So let’s talk about that in practice. So if there’s a car accident and the doctor is treating the injured victim, how does that doctor know who the at fault party is. That may be hard to determine that may be hard information to get. You know, sometimes, there’s not police reports, sometimes there’s not public information that will allow doctors to get, you know the information on the negligent party, so it’s impossible in certain situations, not impossible but very difficult for these doctors to abide by the statute and send the written notice required to the negligent party to make sure to perfect their lien to get paid. So what I always recommend to doctors and physicians and PT places is just reach out to the lawyer. And the best way to get the lawyers information handling the case is information is to ask the patient, Say, look, do you have a lawyer, what’s his name, what’s his number? What’s his mailing address? And then what you do is you just send a notice of the lien or a copy of the lien to the lawyer who’s handling the injury case. So in practice, if one of my clients got treatment at an ER, that ER could just ask my client, who’s your lawyer? And that facility, that doctor that ER place could just send me a letter and look, even though that doesn’t abide by the statute to the letter, I always value doctors sending me their bills because I don’t want my clients credit to be harmed and I have an interest in protecting them, so it’s not like we disregard that. So even though it is not complaint with the statute per se, I always recommend doctors and facilities to just reach out to that lawyer, send a copy of the lien, and your bill and ask that they be paid out of the settlement. And I’m telling ya, if there is a good lawyer on the case, that good lawyer is going to want to make sure and protect their clients’ interests and if that requires paying off bills that are not actual liens, then so be it. So that’s a big piece of advice I always give facilities, uh, even when they can’t abide by the statute.

Carrie:  Awesome, Ok, we have a few question that were submitted. Margie asked, Does the Missouri Hospital Lien Statute apply to people on Medicare or Medicaid?

Stephen: Yea, the Missouri Hospital Lien Statute applies to anybody with any kind of health insurance or not. It doesn’t matter. It’s my understanding that any facility, any medical doctor with any situation where there is a negligent party that caused an injury to their patient, they can use the Missouri hospital lien statute to try and get their bill paid.

Carrie: OK, thanks. The Next question is from Barb. If we submit a lien for our services, how long are we going to have to wait until we get paid?

Stephen: You know, that’s a hard uh question to answer, I think if I looked at it statistically, most of our cases settle anywhere from 9 – 12 months to 18 months after we are retained. It depends upon just common thing such as how much treatment is going to be involved. You know is there disputed liability situation, is there insurance issues, do we have car insurance that has lapsed. All kinds of potential issues that could drag out that typical 12 – 18 month period but generally speaking I think if I looked at out statistics when we’re signed, when a client retains us to help them on a car wreck, most of the time those case are resolved and a settlement is achieved within 12 – 18 months.

Carrie: Ok, the next question is from Brooke. What happens if I submit a lien against a personal injury settlement, give all kinds of treatment and then for some reason you drop the case or no settlement is awarded?

Stephen:  you know well, there’s a couple potential issues there. You know if we’re handling a case. And we determine that we can’t win the case, we will disengage the client because it’s a non-winning case and we don’t take on cases unless we can get value for our clients. So that’s a situation where there would be no more attorney client relationship. However the lien has nothing to do with the lawyers. OK That’s why the lien statute says the doctors have to mail their bills and their notice of lien to the negligent party. So typically that goes to the negligent party’s insurance company, their car insurance company, right? So let’s say that the negligent driver had State Farm. And the facility, the doctor sends the notice of lien to State Farm because that’s the negligent party’s insurance company. Well in that situation it doesn’t matter who the lawyer is representing the injured party right? If they didn’t have our firm or if we decide not to move forward with the case and they went to another lawyer, that lien is still perfected, so whether or not the case is dropped by us or they hire different lawyers, that’s really a non-issue, the statute doesn’t really view that as an issue in perfecting payment.

Carrie: Last question, and it’s my own. If a provider wants to start a relationship with an attorney for the purpose of helping uninsured patients by treating them on liens, how do they go about doing that?

Stephen: I’m actually glad you asked that, because we do have uh, you know there are certain situations where there is you know a client comes to us and they don’t have health insurance and even with Obamacare, certain folks don’t have health insurance and there is nothing we can do about that and some of them don’t have even state health insurance so there’s nothing there. Um in those situations what we do is, as far as getting treatment for our clients and making sure the doctors who provide that treatment are paid we have, we have, we are more than willing to have a relationship with a doctor or a physical therapist or a facility that does MRI scans that basically says look, if you provide good patient care to our client, your patient then we will do whatever we can to go get payment from the at fault party. So that could be anything from folks who aren’t insured to people who with health insurance, to people that have medical payments coverage on their own car insurance policy. So lots of situations where that could potentially arise we always say, and as I stated earlier in this interview we always do our best to see to it that our doctors, our clients doctors are paid because that the right thing to do. They provided the care that got our client better and that’s the right thing to do. So a good place for doctors and facilities to start looking for folk like that, lawyers to team up with, to make sure that their patients are provided good patient care but also their bills get paid is to search the internet. You can go to our website which is You can look at client reviews on Facebook you can go to google Plus. And you can always give me a call too. Our number is simple to remember, it’s (314) 444-4444. I always speak to doctors and in fact I just actually had a call from a physical therapy place, last week that said, we’ve got a couple patients who don’t have health insurance. They were involved in crashes, you know can you help us get our bill paid. You know we’re kind of bill collection agents for doctors and we aren’t paid by them. If you look at it that way. We don’t charge doctors or facilities to get their bill paid. We get that from the at fault party’s insurance carrier.  So it’s really easy for doctors and physical therapists and chiropractors to use us to represent their patients to get proper compensation from negligent party. And at the same time we actually get their bills paid. And it’s a free collection agent of sorts. So, anyway folks can always call me at our main number to talk to me about that and to establish that relationship to work towards out common goals which are again, to provide good patient care to clients and to make sure those doctors and those facilities are paid at the end of the day.

Carrie: Thanks for joining us today, everyone, I hope you can take something valuable away from this presentation. I know I learned something.

Schultz & Myers Personal Injury Lawyers is a personal injury law firm based in St. Louis, Missouri with offices in St. Louis Missouri. We are available by phone, email and the web 24/7.