Hospital Takes Over Personal Injury Victim on Right to Place Liens

Hospital Takes Over Personal Injury Victim on Right to Place Liens

Very recently in the case of Kight v. MCG Health, S14G0603, 2015 Ga. LEXIS 154, Kight received treatment at MCG following a car wreck caused by an allegedly intoxicated driver. Ideally, if one is injured in an accident which involves a personal injury settlement, he/she may have to repay the party who paid for the medical expenses after he/she wins the case. This procedure is called a lien where the state or federal government, health insurance companies and hospitals can assert a claim against such personal injury settlement.

Kight was a member of the [Blue Cross/Blue Shield] managed health care insurance plan, and the hospital care furnished to Kight for injuries he suffered in the accident was covered under a contract between the Hospital and Blue Cross. Under the contract, the Hospital agreed to discount its billed charges for covered hospital care and accept the discounted amount as “payment in full” for the covered care provided to Blue Cross members. The contract allowed the Hospital to bill Kight directly for deductibles and co-pays owed by Kight to the Hospital, but the Hospital agreed under the contract not to balance-bill Kight for the difference between the Hospital’s billed charges and the discounted amount due under the contract.

On March 21, 2007, the Hospital filed a $36,177.68 lien against Kight’s cause of action pursuant to OCGA § 44-14-470 for the “reasonable charges” of hospital care furnished to Kight from February 4 to February 20, 2007. At that time, the Hospital had been compensated by insurance payments for the bulk of its discounted charges, but, as found by the Court of Appeals, “the amount still owed to the Hospital under the Blue Cross contract for care furnished from February 4 to February 20 was $261.10 in unpaid discounted payments due from Blue Cross, and $186.48 in unpaid deductibles or co-pays due from Kight.” Following the filing of the lien, Kight continued to receive care, and, as of April 5, 2007, Kight owed the Hospital a total of $863.10 in deductibles or co-pays. The Hospital modified its lien to reflect this amount, and stated that this was the only amount that they wished to recover.

Considering the purpose of the lien statute and the facts of the case, it became clear that the Hospital’s lien was valid at the time it was filed. The Hospital’s contract with Blue Cross explicitly reserved the Hospital’s right to collect deductibles and co-pays directly from Kight, irrespective of the agreement to hold Kight responsible only for a discounted price of treatment.

Based on the above assertions and analysis the Supreme Court of Georgia held that Hospital’s lien was valid and the award of attorney’s fees against MCG pursuant to OCGA § 13-6-11 was improper.

Very recently in the case of Kight v. MCG Health, S14G0603, 2015 Ga. LEXIS 154, Kight received treatment at MCG following a car wreck caused by an allegedly intoxicated driver. Ideally, if one is injured in an accident which involves a personal injury settlement, he/she may have to repay the party who paid for the medical expenses after he/she wins the case. This procedure is called a lien where the state or federal government, health insurance companies and hospitals can assert a claim against such personal injury settlement.

Kight was a member of the [Blue Cross/Blue Shield] managed health care insurance plan, and the hospital care furnished to Kight for injuries he suffered in the accident was covered under a contract between the Hospital and Blue Cross. Under the contract, the Hospital agreed to discount its billed charges for covered hospital care and accept the discounted amount as “payment in full” for the covered care provided to Blue Cross members. The contract allowed the Hospital to bill Kight directly for deductibles and co-pays owed by Kight to the Hospital, but the Hospital agreed under the contract not to balance-bill Kight for the difference between the Hospital’s billed charges and the discounted amount due under the contract.

On March 21, 2007, the Hospital filed a $36,177.68 lien against Kight’s cause of action pursuant to OCGA § 44-14-470 for the “reasonable charges” of hospital care furnished to Kight from February 4 to February 20, 2007. At that time, the Hospital had been compensated by insurance payments for the bulk of its discounted charges, but, as found by the Court of Appeals, “the amount still owed to the Hospital under the Blue Cross contract for care furnished from February 4 to February 20 was $261.10 in unpaid discounted payments due from Blue Cross, and $186.48 in unpaid deductibles or co-pays due from Kight.” Following the filing of the lien, Kight continued to receive care, and, as of April 5, 2007, Kight owed the Hospital a total of $863.10 in deductibles or co-pays. The Hospital modified its lien to reflect this amount, and stated that this was the only amount that they wished to recover.

Considering the purpose of the lien statute and the facts of the case, it became clear that the Hospital’s lien was valid at the time it was filed. The Hospital’s contract with Blue Cross explicitly reserved the Hospital’s right to collect deductibles and co-pays directly from Kight, irrespective of the agreement to hold Kight responsible only for a discounted price of treatment.

Based on the above assertions and analysis the Supreme Court of Georgia held that Hospital’s lien was valid and the award of attorney’s fees against MCG pursuant to OCGA § 13-6-11 was improper.