Everything A Cyclist Should Know About Medical Liens in a Bicycle Crash Case

Medical Liens in Your Bicycle Crash Case

Have you ever been asked whether or not you want the good or the bad news first? Often when it comes down to medical liens in your bicycle accident case there is only bad news and worse news with the occasional AWESOME news!

Lets break it down with some very basic info and examples. But first, every cyclist should know the bad news, the worse news, and the awesome news:

  1. Bad News: In general you will be dealing with multiple types of liens resulting from your bicycle accident case. Each type of lien has different rules and an experienced bicycle lawyer can help navigate this for you.
  2. Worse News: Valid liens must be paid prior to you or your attorney getting paid. If there are NO liens then you may be held responsible for paying the medical bills on your own.
  3. Awesome News: Some liens can be invalidated and therefore do not get paid. Typically all liens can be negotiated to lower amounts with an experienced bicycle lawyer.

Injured Cyclist Hypothetical Fact Pattern: So a cyclist is hit by a car and gets injured pretty badly. The cyclist is transported to the hospital via ambulance (or helicopter, etc.). The hospital treats the cyclist in the ER and then moves them upstairs for a few days where multiple surgeries take place. Upon discharge from the hospital the cyclist appropriately seeks treatment with his/her own doctors for chiropractic care, massages, physical therapy, and maybe even additional/follow up surgical procedures. Finally the treatment is done and your bicycle lawyer settled your case with the insurance company. What happens next?

Identify the Liens

Lets identify the liens in your case. If you are on Medicare then “congratulations” your liens are a difficult mess and must be handled carefully. There are lots of specific rules here that we won’t get into in order to keep things simple. Let me say this, Medicare has a special priority lien on a federal level. The good news is that they pay small contracted amounts to the medical providers and in Arizona the balance of that bill is off the table for collection and payment! In other words, there is no “balance billing” allowed and an experienced bicycle lawyer can get your Medicare lien reduced even further and the balance of your bill wiped away. The good news here is that when Medicare is involved they are typically the only lien holder (so long as they are the ones paying for all of the medical treatment).

If you are not on Medicare then you will be dealing with other types of liens. Of course, the transportation service (i.e. ambulance or helicopter, etc.) may have a lien as well. Some ambulance companies don’t lien at all, while others do. Either way lets break it down a bit further.

Starting with the hospitals and the doctors. A.R.S. 33-931 makes the business of liens in Arizona a statutory affair. 33-931 basically declares that any and all persons or companies providing medical treatment to you as an injured cyclist is entitled to place a lien on the proceeds of your settlement. Further, the lien granted by 33-931 extends to all claims of liability except health insurance and Underinsured or Uninsured motorist coverage (UM/UIM proceeds). So lets assume that the driver who hit you only has $15,000 of insurance coverage. As lame as that sounds that is actually a common issue in Arizona. But your medical bills are $175,000 ($100K in Hospital and Ambulance services + $75k in all other doctors) – all $175,000 has liens. You were smart and bought UM/UIM coverage under your automobile policy (And yes, UM/UIM auto insurance covers you on your bicycle so long as you are hit by a car!). Your UM/UIM is $250,000.

Is the Medical Lien Perfected?

The basic gist in this pretend scenario is that your bills of $175,000 may only be paid out of the $15,000 thanks to A.R.S. 33-931 and may not tap into the $250,000 UM/UIM. There are some notable exceptions, and of course the statutory reimbursement rights of medical providers just can’t be that easy. Lets review some of the rules pertaining to when medical liens are valid or invalid.

  1. The lien must be perfected or it is invalid. A.R.S. 33-932
    1. Among MANY other requirements (i.e. specific names, dates, amounts, etc.) there is a strict 30 day rule. The medical provider must record it’s lien within 30 days of providing the last treatment to you as the injured cyclist.
    2. Hospital & Ambulance Service Exception: the 30 day rule is waived and altered for hospitals and ambulances. They merely have to record the lien 30 days prior to the case settlement date or judgment payment date. A.R.S. 33-932(D).
  2. R.S. 33-931 & 33-932 Only applies to medical care providers and not to injured cyclist’s own health insurance, Medicare, or AHCCCS, etc. Health insurance liens are entirely different.

Medical LiensPerfecting a lien in AZ is tricky business. Lets get back to our story and highlight a few facts to better explain how this lien could go several ways. So now you have your settlement totaling $265K ($15K from the driver + $250K from your own UM/UIM insurance coverage). The hospital and ambulance liens are $100K and the other doctors are $75K. Lets assume that all of your medical providers strictly complied with the lien requirements and timely perfected their liens. In this example all $175K is only subject to the $15K with no balance billing to the UM/UIM. And any amounts wherein a lien was not timely filed would be subtracted from the $175 and declared invalid by your experienced bicycle lawyer.

Do I have to Reimburse my Health Insurance Because of a Subrogation Lien?

More common is the fact that your own health insurance is notified by the medical provider (and in some cases by you) that you are seeking treatment. This is a wise idea so that the Medical providers to bill you directly for the services they provide. Remember that lien or no lien you are responsible for paying for the medical services you receive. A lien simply makes a portion of those funds mandatory to pay before you get paid when the case settles.

If and when your health insurance pays the hospital for its services, there will be a balance created between the medical provider’s (hospital, doctor, etc.) bill/lien and the amount your health insurance actually paid. Your health insurance is entitled to reimbursement for the monies it paid out on your behalf when a 3rd party (i.e. the driver) is responsible for the bike crash. This is called a subrogation lien. Unlike the other liens we discussed so far, a subrogation lien can collect from the UM/UIM portion of the proceeds!

Subrogation liens are also tricky business as they are typically federal in nature and fall under the ERISA statutes. ERISA sec 502(a)(3)(b) grants a civil enforcement action – a.k.a. a reimbursement action for payment on medical services by your health insurance. There are a ton of complicated ERISA issues your attorney must understand before dealing with an ERISA lien including such things as whether or not the plan was self funded, etc. These variables may invalidate the subrogation lien your health insurance is claiming.

So in our little story if the $175K in liens totaled approximately $125K in subrogation liens (just a hypothetical) then your settlement of $265K can be tapped for the full amount of $175K since the subrogation liens apply to UM/UIM proceeds. Of course, an experience bicycle lawyer will negotiate those liens down for you and not just blindly pay them out. That way there is always more money for you the client – which goes right in your pocket. That is the awesome news!

If there are no valid subrogation liens, or your insurance company has not notified you and/or your attorney of a lien then you may cautiously proceed with settlement disbursement with appropriate waivers in place so long as you and your attorney understand the risks. If you or your attorney decide to inform your health insurance company that the treatment sought was due to a bicycle accident where a 3rd party (the at fault driver) is responsible for paying then you may open yourself up to adding a subrogation lien when arguably there may not have been one that existed until you notified them. Many attorneys advise their clients to proceed with notification of settlement to their health insurance company so as to not risk a lawsuit later to collect on an ERISA reimbursement (i.e. Subrogation lien).

What Do I Do if I Get Medical Bills in the Mail? How Will My Bills be Paid Until My Case Settles?

Surprisingly this happens often. Your choices are actually quite simple, perhaps not comfortable, but simple. You should understand first that the at fault driver’s insurance company could careless if you are getting billed by your doctors and hospitals. They will not pay these bills during your treatment and will only maybe pay them after your done seeing ALL of your doctors. So what happens to the bills you keep getting in the mean time? Just as in any other billing or collection effort, sadly you are initially responsible for handling your medical bills. Your options are:

  1. Pay them your self. Retain all receipts and submit them to your attorney who will argue for reimbursement of these expenses on your behalf as part of your case. This is unrealistic for most clients.
  2. Submit them to your health insurance and have them cover your expenses. This of course may result in a subrogation lien, but at least you are not initially out of pocket. Keep track of all your co-pays and deductibles as you are entitled to reimbursement of those expenses and costs as well.
  3. Contract with doctors who will work on a lien basis for you. In other words, the personal injury industry is well established and there are medical providers who see patients and hold off on their billing until your case settles. They then they get paid out of the proceeds of your settlement based on their liens they put in place. And, as is typical, their liens will most likely be negotiated.
  4. Apply for a loan against your projected personal injury settlement which you can then use for payment of your medical expenses. I have serious reservations about this option as the case is rarely so easy to determine value. Worse, your loan comes at a cost of interest, fess, etc. that these industry specific injury loan companies love to charge. Most often the loans are not easy to get either.
  5. Do nothing and go into collections. Bill collectors begin calling, and doing their thing. Eventually when you receive your settlement proceeds you can begin paying them.

Medical Liens in Your Bicycle Accident Case Conclusion

In conclusion, liens are a tricky business and best handled by an experienced bicycle lawyer. You may end up with Medicare liens, Medical Provider liens, subrogation liens, lien perfection and timing issues, and more. Be sure that the liens are fully dealt with prior to accepting any money in your case from your attorney. Insist that you see proof of payment and a balance sheet showing the total funds disbursed and to whom. Liens can bring bad news, worse news, and sometimes awesome news!

Arizona based bicycle accident lawyer Ben Dodge

Ben-&-BikeIf you, or someone you know were injured in a bicycle accident caused by road debris, hire a personal injury attorney who is experienced and has a successful track record. Ben dodge, a licensed bicycle accident lawyer in Arizona, has dedicated his entire firm to one purpose: representing cyclists. Bicycle accident cases are the only cases Bike Accident Attorneys, PLC handles. Home based out of the great state of Arizona, Ben can still help cyclists in the entire United States.

Ben Dodge has represented and assisted bicycle accident victims across the entire united states. As an avid and competitive cyclist himself, Mr. Dodge currently participates in national and local cycling events all over the country. It isn’t uncommon to spot him in early morning hours out riding his bike. The day he fell in love with his job was the day he devoted himself completely to bicycle accident cases.

Ben represents cyclists injured in bicycle accidents, at the police station, with insurance companies, and in the courts. He advocates for the rights of all cyclists, not just his clients. He teaches the police about bike laws and bike safety, he educates drivers about the rules of the road, and he trains cyclists and clubs to ride more safely.

A consultation with experienced Arizona bicycle accident attorney Ben Dodge is free

In recent years there has been approximately 700 bicycle fatalities in the united states every single year. Approximately 2,000 bicycle accidents are reported in Arizona every year. approximately 30 fatal bicycle accidents are reported in Arizona every year. Bicycle fatalities are terrible and horrific tragedies that affect the lives of too many families and friends to count. Understanding your rights and obligations as a cyclist can bring clarity to your specific accident situation. It will always be in your best interest to be represented by an attorney who knows the bicycle laws and has a successful track record of winning bicycle accident cases. The negotiation tactics and strategies of winning a case are extremely important but should always take a back row seat to the litigation experience and knowledge of court room rules, local, state, and federal rules of civil procedure that can have significant impact on your bicycle accident case. It is wise to be represented by someone well versed in bicycle accident law, local and state bicycle ordinances, rules, regulations, policies, and laws. You should hire someone very familiar with negligence and tort law, civil procedure, and the rules of evidence as they all relate specifically to bicycle accident cases.

Ben dodge always offers a complimentary in person consultation to all local cyclists and a complimentary phone consultation to any cyclist injured in a bike accident. Typically the consultations are schedule from 30-60 minutes depending on the severity of the accident. You can expect to get answers to questions, clarity, information, and reassurance of your personal bike accident liability and potential for recovery. In your free consultation you can generally expect to discuss such topics as:

  • your specific bike accident details, diagrams, and pictures from your perspective and then from the perspective of your bike accident attorney.
  • the applicable local, state, and federal laws underlying your case.
  • your cyclist’s rights, obligations, and any potential liability.
  • the process, procedure (in and out of court), and the time frame required to conclude your case.
  • the value of your case and what you might expect as compensation.

You can call Arizona bicycle lawyer Ben Dodge of bike accident attorneys, PLC at 1.855.663.3922. Mr. Dodge’s staff is standing and ready to accept your call 24 hours a day, 7 days a week, every single day of the year. Ben will personally return your call within 24 hours. there is never an obligation for a complimentary consultation with Mr. dodge. His passion is in representing cyclists and his entire office stands ready to serve with kindness and patience.

Bike Accident Attorneys, PLC

Call Ben Dodge, the Bicycle Lawyer today at 1.855.663.3922. Reach him by fax at 1.800.958.8902.

Mr. Dodge can also be reached by email at ben@bikeaccidentattorneys.com

His main Arizona offices are located at:

Mesa Arizona (home base office)
4824 E. Baseline Rd., Suite 124
Mesa, Arizona 85206

Phoenix Arizona office
2415 e. Camelback rd., suite 700
Phoenix, Arizona 85016

Tucson Arizona office
One South Church Avenue, 12th Floor
Tucson, Arizona 85701

Mr. Dodge represents cyclists in the entire state of Arizona including but not limited to mesa, phoenix, tucson, yuma, gilbert, peoria, glendale, scottsdale, ahwatukee, tempe, chandler, prescott, sedona, flagstaff, surprise, kingman, page, lake havasu city, payson, goodyear, buckeye, queen creek, paradise valley, show low, winslow, maricopa, nogales, globe, avondale, cave creek, fountain hills, apache junction, carefree, wickenburg, pinetop-lakeside, strawberry, anthem, safford, and more. Ben Dodge is currently involved with bicycle accident cases all over the country and can assist in representation in all 50 states.

Legal EPO | What Every Cyclist Should Know About The Controversial Performance Boost.

What are the 3 most controversial letters in cycling? Without a doubt you can ask Lance Armstrong or his haters and get the same answer: EPO. Many in the cycling world want to credit Armstrong’s seven Tour de France titles to his blood doping habit and scandal with EPO. At the risk of sounding like I support Lance Armstrong in his decision to dope (which I can never do; doping is absolutely ridiculous) I truly feel like even if he wasn’t doping he would likely have still won those seven titles.

But what’s worse is that new research released hints that use of recombinant human erythropoietin (rHuEPO – a.k.a. blood doping, EPO, etc.) in elite cyclists such as Armstrong isn’t likely to increase performance any ways. A new study published in the British Journal of Clinical Pharmacology conducted by some Dutch scientists confirms that EPO use among elite athletes has very little effect in performance if any effect at all.

So what does EPO do exactly? rHuEPO became an endurance athlete’s drug of choice after it was shown to increase red blood cell mass and exercise capacity in patients suffering from anemia from chronic kidney disease. This resulting boost to the oxygen uptake (VO2max) could help performance in endurance athletes.

Why is it likely that it didn’t help Lance Armstrong? The math concept behind EPO is plain enough: increased oxygen in your muscles = improved performance. Simply because an elite athlete is at a fitness level very different than that of a patient suffering with anemia from chronic kidney disease. Elite athletes already have such a high VO2max that EPO can only effect a small change in oxygen uptake therefore having a little effect on performance. It would be like trying to warm a bucket of cold water by adding a single drop of hot water.

The Dutch scientists found that the VO2max in elite athletes was already 50%-100% higher than those in normal healthy young people. Also, VO2max in elite athletes plateaus while performance continues to improve through other factors such as muscle capillary density muscle metabolic adaptations, efficient biomechanics, and more. So any increase in VO2max was of negligible performance gain.

DopingWhat’s worse? In fact, the Dutch found that using EPO carried significant and harmful side effects that could negatively effect an elite athlete’s performance such as Hypertension, Clots, and Inflammation. It would appear based on this research that elite athletes should shy away from EPO as the risks far outweigh any performance gain they can hope to achieve.

So what about those of us who are not elite like Lance Armstrong? The Dutch authors note that moderately trained athletes can improve performance through a variety of factors, including a boost to VO2max. So for those of you who are average cyclists and want to get faster EPO may work very well for you.

Wait, but I thought EPO was illegal? It is. Doping is definitely illegal. There are legal EPO style of supplements that can help boost your cycling performance. One my personal favorites is beet juice. That is right. Nitrate free beets are natures very own EPO drug! A study showed that cyclists drinking a half liter of beetroot juice prior to cycling exercise made them 3% faster and increased their power output as well as their ratio of power output to oxygen expenditure. Great news except beet juice can taste awful or the amount of beets you have to have on hand to take it daily can be crazy expensive. Fortunately there are many products on the market that have concentrated forms of beet juice, or beet juice powder. I personally like BeetElite carried in some local bicycle shops or widely available online.

Even more controversial is the new supplement out in the market called EPO-BOOST®. Meant to be taken daily and intentionally derived from the controversial cycling drug lingo “EPO”, this supplement claims to increase your naturally occurring EPO by 90% compared to their own study with a placebo group. A quick Google search of the product and you will see many athletes taking it and swearing by it. It is heavily marketed in the various cycling magazines and circles. All ingredients are in strict compliance with WADA, UCI, IOC, and NCAA rules thereby allowing athletes to pass drug testing.

Of course, the potency of this legal product EPO-BOOST® must inevitably be less than the illegal Lance Armstrong blood doping sort used in the Tour de France. And yet the same risks involved with EPO use are surely present as well as the same analysis for elite athletes.

I’m left to conclude that:

  1. Lance Armstrong would likely have won seven titles anyways.
  2. Illegal EPO use is not worth the risks for the marginal and very questionable performance gains.
  3. And finally, that for those of us who are not as elite as Lance Armstrong our performance can most certainly be improved in lots of ways that don’t include want-a-be EPO products but focus instead on disciplined training and eating habits. But for the heck of it we may actually see a boost in our performance from Beet Juice or products like EPO-BOOST®.

Arizona based bicycle accident lawyer Ben Dodge

Ben-&-BikeIf you, or someone you know were injured in a bicycle accident caused by road debris, hire a personal injury attorney who is experienced and has a successful track record. Ben dodge, a licensed bicycle accident lawyer in Arizona, has dedicated his entire firm to one purpose: representing cyclists. Bicycle accident cases are the only cases Bike Accident Attorneys, PLC handles. Home based out of the great state of Arizona, Ben can still help cyclists in the entire United States.

Ben Dodge has represented and assisted bicycle accident victims across the entire united states. As an avid and competitive cyclist himself, Mr. Dodge currently participates in national and local cycling events all over the country. It isn’t uncommon to spot him in early morning hours out riding his bike. The day he fell in love with his job was the day he devoted himself completely to bicycle accident cases.

Ben represents cyclists injured in bicycle accidents, at the police station, with insurance companies, and in the courts. He advocates for the rights of all cyclists, not just his clients. He teaches the police about bike laws and bike safety, he educates drivers about the rules of the road, and he trains cyclists and clubs to ride more safely.

A consultation with experienced Arizona bicycle accident attorney Ben Dodge is free

In recent years there has been approximately 700 bicycle fatalities in the united states every single year. Approximately 2,000 bicycle accidents are reported in Arizona every year. approximately 30 fatal bicycle accidents are reported in Arizona every year. Bicycle fatalities are terrible and horrific tragedies that affect the lives of too many families and friends to count. Understanding your rights and obligations as a cyclist can bring clarity to your specific accident situation. It will always be in your best interest to be represented by an attorney who knows the bicycle laws and has a successful track record of winning bicycle accident cases. The negotiation tactics and strategies of winning a case are extremely important but should always take a back row seat to the litigation experience and knowledge of court room rules, local, state, and federal rules of civil procedure that can have significant impact on your bicycle accident case. It is wise to be represented by someone well versed in bicycle accident law, local and state bicycle ordinances, rules, regulations, policies, and laws. You should hire someone very familiar with negligence and tort law, civil procedure, and the rules of evidence as they all relate specifically to bicycle accident cases.

Ben dodge always offers a complimentary in person consultation to all local cyclists and a complimentary phone consultation to any cyclist injured in a bike accident. Typically the consultations are schedule from 30-60 minutes depending on the severity of the accident. You can expect to get answers to questions, clarity, information, and reassurance of your personal bike accident liability and potential for recovery. In your free consultation you can generally expect to discuss such topics as:

  • your specific bike accident details, diagrams, and pictures from your perspective and then from the perspective of your bike accident attorney.
  • the applicable local, state, and federal laws underlying your case.
  • your cyclist’s rights, obligations, and any potential liability.
  • the process, procedure (in and out of court), and the time frame required to conclude your case.
  • the value of your case and what you might expect as compensation.

You can call Arizona bicycle lawyer Ben Dodge of bike accident attorneys, PLC at 1.855.663.3922. Mr. Dodge’s staff is standing and ready to accept your call 24 hours a day, 7 days a week, every single day of the year. Ben will personally return your call within 24 hours. there is never an obligation for a complimentary consultation with Mr. dodge. His passion is in representing cyclists and his entire office stands ready to serve with kindness and patience.

Bike Accident Attorneys, PLC

Call Ben Dodge, the Arizona Bicycle Lawyer today at 1.855.663.3922. Reach him by fax at 1.800.958.8902.

Mr. Dodge can also be reached by email at ben@bikeaccidentattorneys.com

His main Arizona offices are located at:

Mesa Arizona (home base office)
4824 E. Baseline Rd., Suite 124
Mesa, Arizona 85206

Phoenix Arizona office
2415 e. Camelback rd., suite 700
Phoenix, Arizona 85016

Tucson Arizona office
One South Church Avenue, 12th Floor
Tucson, Arizona 85701

Mr. Dodge represents cyclists in the entire state of Arizona including but not limited to mesa, phoenix, tucson, yuma, gilbert, peoria, glendale, scottsdale, ahwatukee, tempe, chandler, prescott, sedona, flagstaff, surprise, kingman, page, lake havasu city, payson, goodyear, buckeye, queen creek, paradise valley, show low, winslow, maricopa, nogales, globe, avondale, cave creek, fountain hills, apache junction, carefree, wickenburg, pinetop-lakeside, strawberry, anthem, safford, and more. Ben Dodge is currently involved with bicycle accident cases all over the country and can assist in representation in all 50 states.

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