Medical Lien Statutes

Arizona Revised Statutes Annotated

Title 33. Property, Chapter 7. Liens, Article 3. Health Care Provider Liens

§ 33-931. Lien of health care provider on damages recovered by injured person receiving services; hospital priority; enforcement

A. Every individual, partnership, firm, association, corporation or institution or any governmental unit that maintains and operates a health care institution or provides health care services in this state and that has been duly licensed by this state, or any political subdivision or private entity with ambulances operated, licensed or registered pursuant to title 36, chapter 21.1, is entitled to a lien for the care and treatment or transportation of an injured person as prescribed by subsection E of this section. The lien shall be for the claimant's customary charges for care and treatment or transportation of an injured person. A lien pursuant to this section extends to all claims of liability or indemnity, except health insurance and medical payments coverage and underinsured motorist and uninsured motorist coverage as defined in section 20-259.01, for damages accruing to the person to whom the services are rendered, or to that person's legal representative, on account of the injuries that gave rise to the claims and that required the services.

B. If a county maintains, operates or provides health care services, the county is entitled to an assignment by operation of law for the care and treatment or transportation of an injured person as prescribed by subsection E of this section. The assignment shall be for the claimant's customary charges for care and treatment or transportation of an injured person. An assignment pursuant to this section extends to any claims of liability or indemnity, except health insurance and medical payments coverage and underinsured motorist and uninsured motorist coverage as defined in section 20-259.01, for damages accruing to the person to whom the services are rendered, or to that person's legal representative, on account of injuries that gave rise to the claims and that required the services.

C. The lien entitlements authorized by subsection A of this section and the assignment authorized by subsection B of this section are applicable to all customary charges by hospitals or ambulances of political subdivisions, but are restricted to customary charges in excess of $250 by all other providers and privately owned ambulance companies excluding interest and service charges.

D. Liens perfected pursuant to this article by a hospital have priority for payment over all other liens authorized by this article.

E. The liens and assignments authorized by this section are enforceable by a cause of action prescribed by section 33-934 and are subject to the following:

1. One-third of any third-party judgment, settlement or award is exempt from any lien or assignment authorized by this section.

2. If the injured person is covered as an insured or dependent under a health insurance or similar medical benefit plan and the health care provider has a valid and binding contract with that insurer or plan as an in-network provider, the contract must expressly allow the health care provider to assert a lien or assignment that is authorized by this section. In the absence of that contract provision, the lien or assignment is invalid and may not be enforced by a cause of action prescribed by section 33-934 except as allowed under paragraph 3 or 4 of this subsection.

3. Paragraphs 1 and 2 of this subsection do not apply if any of the following exceptions are met:

(a) The services provided are not covered by the injured person's health insurance or similar medical benefit plan.

(b) The health care provider does not have a valid and binding contract with the insurer or plan as an in-network provider.

(c) The injured person is not covered by any health insurance or any similar medical benefit plan.

(d) The injured person and the health care provider have a written and signed document stating that they elect not to use any coverage potentially available under a health insurance or similar medical benefit plan that covers the injured as an insured or dependent.

4. Notwithstanding paragraphs 1, 2, and 3 of this subsection, a health care provider may enforce a lien or assignment authorized by this section by a cause of action prescribed by section 33-934 for all amounts for which a patient is personally responsible, including outstanding coinsurance amounts, copayments and deductibles that are due under the injured person's or dependent's health insurance or similar medical benefit plan.

5. Any valid and enforceable lien or assignment authorized by this section shall be compromised pursuant to the criteria prescribed by section 33-937.

6. Any valid and enforceable lien or assignment authorized by this section shall be subordinate to any lien with higher priority.

F. This section does not affect the rights of a health care provider to enforce a consensual agreement, whether called a lien or contract, against the patient who has signed the agreement.

§ 33-932. Perfecting lien; statement of claim; recording; effect

A. In order to perfect a lien granted by § 33-931, the executive officer, licensed health care provider or agent of a health care provider shall record, before or within thirty days after the patient has received any services relating to the injuries, except a hospital which shall record within thirty days after the patient is discharged, in the office of the recorder in the county in which the health care provider is located a verified statement in writing setting forth all of the following:

1. The name and address of the patient as they appear on the records of the health care provider.

2. The name and location of the health care provider.

3. The name and address of the executive officer or agent of the health care provider, if any.

4. The dates or range of dates of services received by the patient from the health care provider.

5. The amount claimed due for health care.

6. For health care providers other than hospitals or ambulance services, to the best of the claimant's knowledge, the names and addresses of all persons, firms or corporations and their insurance carriers claimed by the injured person or the injured person's representative to be liable for damages arising from the injuries for which the person received health care.

B. The verified statement shall also include the amount claimed due as of the date of recording of the claim or lien and a statement regarding whether the patient's treatment has been terminated or will be continued. Amounts incurred during the continued period are also subject to the lien.

C. The claimant shall also mail, by first class mail within five days after recording the claim or lien, a copy of the claim or lien to the injured person. For health care providers other than hospitals or ambulance services the claimant shall also mail a copy to all persons, firms or corporations and their insurance carriers claimed by the injured person or the injured person's representative to be liable for damages arising from the injuries for which the person received health care. If a health care provider other than a hospital or ambulance service does not record the claim, lien or assignment as provided in this section, the claim, lien or assignment is invalid and may not be enforced by the cause of action provided in § 33-934. If a hospital records such a claim or lien, the recording shall be notice to all persons, firms or corporations liable for damages, whether or not they are named in the claim or lien.

D. A hospital or ambulance service lien that is not recorded within the time prescribed by this section is effective against any settlement or judgment for damages if the lien is recorded thirty days before the settlement is agreed to or the judgment is paid except if the lien is recorded in a county where liens are accessible on the internet, the lien is effective if the lien is accessible on the internet thirty days or more before the settlement is agreed to or the judgment is paid. If the lien is not recorded or is not accessible on the internet as provided in this section, the lien is invalid and may not be enforced by the cause of action provided in § 33-934.

§ 33-933. Recording and indexing lien claim

The recorder shall endorse upon a claim recorded as provided by § 33-932 the date and hour of reception, and such facts as are necessary to indicate that it has been recorded.

§ 33-934. Release of claim by injured person ineffective as to lienholder; action to enforce lien

A. A release of claims on which a lien or assignment is given by § 33-931 or of any judgment on that claim is not valid or effectual against the lien or assignment unless the lienholder or assignee joins in the release or executes a release of the lien or assignment. If any amount has been or is to be collected by the injured person or that person's legal representative from or on account of the person, firm or corporation liable for damages by reason of a judgment, settlement or compromise, the claimant or assignee of the lien or assignment may enforce the lien or assignment by action against the person, firm or corporation that is liable for damages, or against any insurer or other person, firm or corporation that is responsible for paying all or part of the damages.

B. An action pursuant to this section shall be commenced and tried in the county in which the lien or assignment is filed, unless ordered by the court to be removed to another county for cause. The court may allow reasonable attorney fees and disbursements to the prevailing party. The action shall be commenced within two years after the entry of the judgment or the making of the settlement or compromise. In an action to enforce a lien or assignment, the lienholder or assignee may not recover more than the amount of the lien or assignment nor may it recover more against a defendant in the lien action than that defendant is obligated to pay under judgment or settlement. The defendant in the lien or assignment action cannot raise as a defense in that action that it is not liable for the amount it is obligated to pay under the judgment or settlement except that it may dispute the amount of the lien on the grounds that the charges giving rise to the lien are erroneous or exceed the customary charges, or that the care, treatment or transportation giving rise to the charges was not medically necessary or causally related to the event giving rise to the claim to which the lien or assignment extends.

C. This section does not create any rights or causes of action on behalf of the lienholder other than are provided for in this section.

§ 33-935. Workers' compensation cases exempted

The provisions of this article are not applicable to accidents or injuries within the purview of the workers' compensation law of this state.

§ 33-936. Release of hospital lien; liability

If any lien or assignment established by this article has been satisfied, within thirty days after satisfaction the lienholder or assignee shall issue a release of the lien or assignment to the person against whom the lien or assignment was claimed. The release shall be a document in a form as specified in § 11-480. A lienholder or assignee that fails to grant a release is subject to liability in the amount of one hundred dollars and also to liability for actual damages.

§ 33-937. Limitation of lien or assignment; compromise; cause of action; attorney fees

A. All interested parties, including the health care provider, patient and patient's attorney, shall compromise any lien or assignment granted pursuant to section 33-931 and the amounts owed pursuant to any such lien or assignment to provide a settlement of the claim that is fair and equitable to all parties.

B. In determining the extent of the compromise required by subsection A of this section, the health care provider shall consider the following factors:

1. The nature and extent of the patient's injury or illness.

2. The sufficiency of liability insurance or other sources of indemnity available to the patient from the tortfeasor or the tortfeasor's insurer. The potential availability of health insurance or a similar medical benefit plan that covers the patient as an insured or dependent may not be considered as a factor in any compromise, if the patient and the health care provider have agreed not to use that health insurance or similar medical benefit plan coverage.

3. Whether the health care provider, the hospital or an assignee has received any payment reducing the patient's financial obligation to pay the lien balance.

4. The nature and complexity of the services rendered by the health care provider to the patient.

5. The health care provider's customary charges for the services rendered to the patient.

6. The total amount of the third-party judgment, settlement or award.

7. Other valid liens made pursuant to section 33-931 that are attached to any third-party judgment, settlement or award and the priority position of the liens.

8. The patient's attorney fees and costs.

9. Any reductions agreed to by any other claimants to the total amount of the third-party judgment, settlement or award.

10. Other valid claims against the third-party judgment, settlement or award, including health insurance reimbursement and subrogation claims.

11. Any other factor relevant to a fair and equitable settlement under the circumstances of that particular case.

C. On request of the health care provider, the patient shall provide a proposed distribution of the settlement monies that contains a complete listing of how the monies would be distributed among all parties along with a statement of the monies that the patient would receive if the liens are compromised.

D. If the interested parties cannot agree on a compromise of a lien or assignment as prescribed by this section, an action may be filed for a judicial determination of an appropriate compromise of the lien or assignment based on the factors prescribed by this section. The action may be filed by the injured person whose care, treatment or transportation is subject to a lien or assignment pursuant to section 33-931, the health care provider or assignee, or the person, firm or corporation liable for damages, or any insurer or other person, firm or corporation that is responsible for paying all or part of the damages. In any action brought pursuant to this section, the prevailing party may not recover attorney fees authorized by section 33-934.