The hospital filed a lien against my settlement. What now?

A hospital lien is a claim the hospital records at the county clerk against whatever you recover from the person who hurt you. It comes from local law, and Miami-Dade and Hillsborough County write theirs differently. In both, a settlement release is not effective against a recorded lien unless the hospital joins it, so the lien has to be resolved before the case closes, not after. In Hillsborough the ordinance caps the lien, splits a short recovery pro rata, and bars the hospital from billing you for the same charges. Miami-Dade’s chapter, written in 1951, does none of that in its text. Neither ordinance replaces a read of the actual lien and the actual bill.

01 What it is

What is a hospital lien on a car accident settlement?

It is a claim on your recovery, not a separate lawsuit against you. When a hospital treats an injured person, a local law in some Florida counties lets the hospital record a claim against the money that person may later recover from whoever caused the injury. The money for the hospital then comes out of the settlement or judgment, before you see it.

It comes from local law, and each county writes its own. Miami-Dade’s lien is in Chapter 25C of the county code, which was codified from a 1951 state act. Hillsborough’s is in Chapter 28, Article IV of its county code, the Hillsborough County Hospital Lien Ordinance of 2001, which incorporates a 1998 state act as amended. The two read differently, and what a hospital in another county can do is a separate question.

A lien is not the same as a bill. A bill says what the hospital charged. A lien says the hospital has recorded a claim against your recovery. You can have a bill and no lien, and a lien that comes out of a settlement can be very different from the bill the hospital first sent.

A bill is a request for money. A lien is a recorded claim on your recovery.

02 Miami-Dade

How does a hospital lien work in Miami-Dade County?

Every hospital in the county has a lien for its reasonable charges. Chapter 25C of the Code of Miami-Dade County gives a hospital a lien for all reasonable charges for hospital care, treatment and maintenance on any claim, suit, judgment or settlement that arises from the illness or injury it treated (§ 25C-3). It does not apply to injuries within the workers’ compensation law (§ 25C-1).

The hospital perfects it by filing with the Clerk. An executive officer or agent of the hospital must file a verified claim with the Clerk of the Circuit Court before, or within ten days after, the patient is discharged. The claim lists the amount claimed and the people the patient says are liable. Within one day the hospital must mail a copy by registered mail to each person claimed to be liable, and the filing itself is notice to everyone who may be liable, named or not (§ 25C-4). The Clerk records it in a hospital lien book (§ 25C-5).

A release does not clear it unless the hospital joins. No release or satisfaction of the claim is valid against the lien unless the hospital joins in it or releases the lien. Taking a settlement without a release of the lien is presumed to impair it, and the hospital may sue whoever accepted the release or made the settlement for the reasonable cost of the care, plus its attorneys’ fees and expenses if it prevails (§ 25C-6).

The chapter’s text sets no cap and no sharing formula. It says “reasonable charges,” which is a question the hospital’s bill and a court can test. The Hillsborough limits below are not in Chapter 25C’s text.

Homestead is in Miami-Dade. A hospital in Homestead operates in the county, so Chapter 25C is the local law for it, as it is for a hospital in Miami, Kendall or South Miami.

03 Hillsborough

How does a hospital lien work in Hillsborough County?

The lien is capped at an “applicable lien rate.” The Hillsborough County Hospital Lien Ordinance limits a lien to that rate. For a patient with commercial health coverage under contract with the hospital, the lien may not exceed the amount the hospital has contracted to accept from all sources for that care. For other uninsured patients it is a rate tied to the Medicare Act’s payment provisions, and for a patient on the county’s indigent plan it is what the county pays under that plan (§ 28-139, § 28-140(2)).

A short recovery is shared pro rata. When the recovery proceeds cannot cover the lien and the patient’s attorney’s fees, they are distributed pro rata. For an uninsured patient the hospital may use its full billed charges to work out its share, but its share may not exceed what Medicare would pay for all the services. If noneconomic damages and future medical costs are not itemized in a settlement, the ordinance sends the dispute to a mediator certified by the Florida Bar (§ 28-139, § 28-140(3)). The ordinance also offsets the cost of an insurance policy that paid part of the lien, up to one year’s premium (§ 28-140(4)), and caps the attorney’s fee used in the lien calculation at 25 percent of the recovery when a lawsuit has been filed (§ 28-140(5)).

The hospital that enforces the lien may not also bill you for those charges. A lienholder that enforces a lien is barred from seeking more from the patient, a family member or a decision-maker for the charges the lien covers, and one that collects any part of the lien may not enforce a letter of protection for the same care (§ 28-141).

The hospital files within 12 months and must mail you a copy. A hospital perfects its lien by filing a verified claim with the Clerk of the Circuit Court no later than 12 months after discharge or the date of service. It must list the amount claimed, how it was calculated, and the known third-party payors. A copy goes by first-class mail within ten business days to the patient, the patient’s attorney if known, and each payor named (§ 28-142). Priority among liens follows the date and time of recording (§ 28-147).

A release still does not clear it. As in Miami-Dade, no release or settlement is effective against a recorded lien unless the lienholder joins it, and accepting one without releasing the lien is presumed to impair it (§ 28-146).

Tampa is in Hillsborough County. The ordinance covers a hospital operating in the county, which includes Tampa General and St. Joseph’s, the two trauma centers named in which hospital the ambulance takes you to.

04 Is it valid

Can a hospital lien be challenged in Florida?

Sometimes, and the questions are specific. The first is whether the lien was recorded in the way the local law requires, within the time it allows, and with the information it lists. The second is whether the amount fits the law of that county. In Hillsborough that means the applicable lien rate, the pro rata rules and the bar on billing you for the same charges. The third is whether the local law itself holds up.

The Florida Supreme Court has already decided one such case. In Shands Teaching Hospital and Clinics, Inc. v. Mercury Insurance Co. of Florida, 97 So. 3d 204 (Fla. 2012), the Court held that the Alachua County special law was unconstitutional under article III, section 11(a)(9) of the Florida Constitution, and held that the county’s separate hospital lien ordinance was not unconstitutional and could be enforced. Miami-Dade’s chapter and Hillsborough’s ordinance both carry text that began as special acts of the legislature. Whether the reasoning of that case reaches either of them is a legal question for Jose A. Dapena to answer from the facts of a particular lien, not something to assume in either direction.

Hillsborough also gives you a written route to complain. A person who knows of an abuse of the lien authority may send the hospital a written statement of the specifics and the relief sought, and the complaint is then heard at an expedited public meeting of the hospital’s governing board (§ 28-149).

05 The settlement

What happens to a hospital lien when my case settles?

It has to be dealt with before the release is signed. In both counties the release does not bind the hospital unless the hospital joins it. A settlement that pays you and ignores a recorded lien can leave the hospital free to pursue the amount, and in Miami-Dade to sue for it and for its fees. So the usual order is to find the liens, learn the true amount, negotiate it where the law allows, and release it in writing as part of the settlement.

The amount is often not the number on the first bill. In Hillsborough the ordinance itself ties the lien to a contracted or Medicare-based rate and divides a short recovery pro rata. In either county the first question is what the hospital actually charged, which you can ask for. A hospital must provide an itemized statement within seven days after discharge or after you ask, whichever is later (§ 395.301(1)(e)).

Your lawyer’s fee and costs come off the same recovery. That is why a short recovery is shared, not simply given to the hospital first. Where the ordinance has a formula, as in Hillsborough, it counts the attorney’s fees and costs. Where it has none, as in Miami-Dade’s text, the amount is negotiated.

06 Other claims

Can a health insurer or Medicaid also claim part of my settlement?

Yes, and each follows its own rule. Under § 768.76, a health insurer or other provider of benefits with a right of reimbursement may recover from your recovery, but only the amount actually recovered, minus its pro rata share of the costs and attorney’s fees spent recovering it. The claimant must notify the provider by certified or registered mail of the intent to claim damages, and a provider that does not answer with a statement of its payments and its right within 30 days of receiving the notice waives that right (§ 768.76(4), (6), (7)).

Medicaid has a fixed formula in Florida. After attorney’s fees, calculated at 25 percent, and taxable costs, one-half of the remaining recovery goes to the agency, up to the total of the Medicaid assistance provided, and the rest goes to the recipient (§ 409.910(11)(f)). Medicare, Medicaid and other programs that carry a federal lien or reimbursement right are not treated as collateral sources under § 768.76 (§ 768.76(2)(b)).

If you are in an HMO, the hospital may have to look to the HMO. If a health maintenance organization is liable for the services, the subscriber is not liable to the provider for those fees, and the provider may not collect from the subscriber while a claim is pending, if it knows or should know the HMO is liable (§ 641.3154). Tell the lawyer who your insurer is before anyone records a lien.

PIP pays hospital bills first. Personal Injury Protection is the first payer for the first emergency care, up to its limits (who pays your medical bills while the case runs). What it did not pay is what a lien tends to be about.

07 Find it

How can I find out whether a hospital recorded a lien against me?

Ask the hospital, and search the Clerk’s official records. Both counties’ liens are recorded with the Clerk of the Circuit Court: Miami-Dade’s in a hospital lien book (§ 25C-5) and Hillsborough’s in the public records (§ 28-144). Each Clerk offers an online official records search, where you can look up recorded documents by name (Miami-Dade Clerk, Hillsborough Clerk).

Read what the hospital mailed to you. In Hillsborough, the hospital must mail you a copy of a lien within ten business days of filing. In Miami-Dade the code requires a copy to each person claimed to be liable, which is not always the patient, so the lien may reach the insurer before it reaches you.

A letter of protection is a different thing. That is a provider’s agreement to wait for payment from your settlement. It is not a recorded lien, and Hillsborough’s ordinance bars a lienholder that collects its lien from also enforcing a letter of protection for the same care (§ 28-141). Florida’s evidence rule for medical expenses treats letters of protection separately (§ 768.0427).

09 What to do now

1. Do not sign a release until every lien is found and resolvedA release does not bind a hospital with a recorded lien unless the hospital joins it.
2. Ask the hospital for the itemized statementA hospital must provide it within seven days after discharge or your request, whichever is later.
3. Search the Clerk’s official records under your nameBoth counties’ liens are recorded there. Save a copy of every claim of lien and every letter.
4. Tell your lawyer about every payerHealth insurer, HMO, Medicaid, Medicare and PIP each follow different rules.
5. Do not promise payment from a future settlementA letter of protection or a payment promise changes what you owe and how it is argued later.
6. Keep the hospital’s mail, and write down any callDates matter: when it was filed, when it was mailed and what amount it claimed.

11 The sources

• Code of Miami-Dade County, ch. 25C Payment of costs of hospital care, treatment and maintenanceA hospital’s lien on claims, judgments and settlements, how it is perfected, and why a release does not clear it unless the hospital joins.
• Code of Hillsborough County, ch. 28, art. IV Hillsborough County Hospital Lien OrdinanceThe lien rate cap, pro rata sharing, the 25 percent fee cap, the bar on billing the patient, perfection within 12 months and the complaint route.
• Ch. 98-499, Laws of Florida Hillsborough County hospital liensThe state act that authorizes the county’s ordinance and limits the lien for patients with contracted coverage.
• Shands v. Mercury Ins. Co., 97 So. 3d 204 Florida Supreme Court, 2012The Court held an Alachua County special lien law unconstitutional and the county’s separate ordinance not unconstitutional.
• Fla. Stat. § 768.76 Collateral sources of indemnityA provider’s reimbursement right, the pro rata reduction for costs and fees, and the notice the claimant must send.
• Fla. Stat. § 409.910 Medicaid third-party liabilityThe share of a tort recovery owed to Medicaid.
• Fla. Stat. § 641.3154 HMO liability; provider billing prohibitedA provider may not collect from an HMO subscriber for services the HMO is liable for.
• Fla. Stat. § 395.301 Itemized patient statement or billA hospital must provide an itemized statement within seven days of discharge or request.