california insurance problems

How Does Lien-Based Medical Treatment Work?

Receiving proper medical treatment after an injury is critical to your physical recovery. If you don't get the right care, the chances that your injury will persist for many months and years is significantly higher. However, with the right treatment after a bad car crash or other type of injury, your chances of a full recovery are much better. But what about the cost of getting the "right" care? Most people don't have the cash or credit to get all the treatment they need, and this applies to people with good health insurance, too. 

Some of the best medical facilities in California accept injury liens.

Some of the best medical facilities in California accept injury liens.

Lien-Based Treatment

Doctors area able to treat you and get paid later - obviously the doctor that treats you and gets a check from your health insurance has to wait a few weeks to get paid. This is one approach to the business of healthcare. Some doctors are willing to provide treatment with the expectation that they will be paid after an injury case settles. The idea is that if you were injured by someone else and there's a lawyer involved who is handling the case and expects to win, the insurance company will eventually be paying on the case. In this situation, the patient signs a lien, meaning that when the case settles, the doctor gets paid before the patient does. For example, if you are injured in a car accident and receive lien-based medical treatment, the sequence goes like this: treatment is received by you, with no out of pocket costs. Then, after your attorney wins the case, or reaches a settlement with the insurance company of the at-fault driver, the money goes into a trust account at the law firm's bank. From there, the attorney must first pay the doctor who has a lien - this contract/lien is in the attorney's file. In this way, the patient is able to get the right medical treatment, and the doctor's office is paid for its services.

Proper diagnosis matters: It isn't enough to just say you were hurt, or that your life has changed. You need the right doctor with the right training to help you reach a full recovery.

Proper diagnosis matters: It isn't enough to just say you were hurt, or that your life has changed. You need the right doctor with the right training to help you reach a full recovery.

Why Might Lien-Based Treatment Be Good for Injured Patients?

Big HMOs can be difficult to schedule appointments with, especially if your treatment requires many follow-up visits, or a consultation with a specialist. We've all had the experience of waiting for a referral to a specialist and being told that so-and-so doesn't have an open appointment for a few weeks. Well, if you need to see an orthopedic surgeon or neurosurgeon today, but you can't get in for a month, your health lays in the balance during that time. Also, the quality of care can be better with doctors who treat on a lien. Many lien-based medical offices, or doctors offices who accept traditional health insurance, as well as cash payments and lien based payments, are privately owned. These doctors are often highly specialized, meaning they are able to sustain their own businesses without the need to be part of a big HMO system or hospital. 

Because the offices tend to be privately owned, the doctors have more say in who they decide to treat, and who they decide they don't want to treat. This means they can control their schedules better, meaning your chances of getting in for an appointment are better. The payment system is also a big issue for a lot of people injured in car accidents, auto versus pedestrian injuries, and slip and fall injuries. Again, because many people don't just have thousands of dollars set aside in their bank account just in case they are injured in a car accident, most people are not ready for what can be expensive medical care after an accident.

Access to the proper specialists without having to wait months for an appointment is one reason many injured people decide to seek lien-based treatment.

Access to the proper specialists without having to wait months for an appointment is one reason many injured people decide to seek lien-based treatment.

How Does Lien Treatment Affect Your Injury Case?

The bottom line is that if you don't get proper medical treatment for your injuries, you can't expect the insurance company to take your word for it and trust you were injured. No medical treatment means no settlement money to compensate you for your loss. For example, if you were injured in a car accident, but due to financial constraints or scheduling conflicts you weren't able to get the medical care you needed, you can't just expect the at-fault driver's insurance company to take a compassionate route and pay you the same amount for your injury as if you went to the doctor. Thus, even with very bad injuries, without the documentation and proper treatment from a doctor, the insurance company will not pay fair money on your claim.

But what is "fair" money anyways? Well, consider a scenario in which two people have identical injuries from the same crash. One person goes to the doctor, sees the specialists he/she is referred to, and reaches a full recovery after a few months. The doctor's notes document the patient's injury step-by-step, from the first visit until the last. Perhaps this person's case settles for $50,000. Now consider the second person does not go to the doctor, although they have the exact same injuries. This person has nothing to "prove" he/she was injured. They may not get any settlement at all. If they do get a settlement, it will likely be around a couple hundred of dollars, known as "nuisance money." If the second person gets $500, that's a difference of $49,500! The difference is the first person sought appropriate and reasonable medical care, and their injuries are documented by a medical professional. Although the second person had identical injuries, they basically walk away with nothing. 

How Can You Find Lien-Based Treatment?

If you got hurt in a car accident, or got hit on your bicycle, or was injured and it was not your fault, you're likely going to need to see a primary care physician, or other general medical practitioner. This may be at the emergency room, or at urgent care, or at your primary care physician's office. The office may refer you to future treatment, and you can ask if they know of offices for the treatment you require who will accept lien-based care. Also, most personal injury law firms are aware of medical facilities that are willing to treat on a lien. A good injury lawyer will have handled lots of injury cases, and so he or she will have worked on files and made payments on past cases to medical offices and doctors who accept lien-based care.

Many top surgeons accept liens. This is one reason some injured clients decide to have their surgeries performed at a private medical clinic rather than at an HMO

Many top surgeons accept liens. This is one reason some injured clients decide to have their surgeries performed at a private medical clinic rather than at an HMO

What Kind of Treatment Can You Get on a Lien?

Name a kind of medical office or specialty and you can find an office that treats on a lien. In California, there are surgeons, chiropractors, MRI facilities, physical therapy offices, holistic medicine, orthopedic surgeons, pain management, podiatrists - the list is basically endless. This is not to say that every office accepts lien-based care, or even the majority. While lien-based treatment is increasingly popular, the majority of medical offices may not be comfortable with this arrangement. However, if a medical office has provided treatment and then gotten paid promptly by a good injury attorney, they are very likely to accept lien-based treatment. For this reason, a medical office may want to know the name of your attorney and the firm he or she works for. If your attorney is a general attorney who does a bit of everything, but does not focus on personal injury exclusively, it is less likely that the medical office will be willing to treat you on a lien. But, if you are represented by a law firm that focuses its entire practice on injury law, the chances that that medical office will be willing to treat you up front at no cost are much higher.

Get an Attorney With a Good Reputation

Because doctors want to work with attorneys who they know will win the case and pay the doctor's bill, it is important that you seek an attorney who has a lot of experience handling personal injury cases. Consider that with the aid of modern technology, the best attorney for handling your injury claim may not be in your town or even your county! Most law firms these days are able to do a lot of work using email, faxes, and video-chat, such that someone located in San Bernardino, for example, might be best off going with a law firm represented in Orange County or Los Angeles County. At the end of the day, you want an attorney who knows injury law backwards and forwards - the chances that you will find an attorney with that kind of experience just by happenstance that is located in your city or town may not be high. Most attorneys in California will agree that the best thing you can do is find an attorney who focuses on one type of case, and has room in his or her schedule to give your case the attention it deserves.

Still Have Questions?

The Lions Injury Lawyers, P.C. focus entirely on personal injury matters. They don't handle any other types of cases but injury claims. They accept car accident cases, auto versus pedestrian (including auto versus bicycle and skateboard), slip and fall, general negligence, products liability, failure to warn, and premises liability. The Lions are not a settlement mill - they won't just settle your case for pennies on the dollar in order to be able to handle more cases. All cases handled by The Lions are handled by an actual attorney. If you have questions about your case, including whether it is worth it to get an attorney, or whether in the end you'll get more money in your pocket by representing yourself or going with a lawyer, you should talk to a lawyer. Call The Lions and talk to a lawyer, not a salesman.  

Back to where you were before the injury - that's what the law says you're entitled to after you're hurt by someone else's negligence.

Back to where you were before the injury - that's what the law says you're entitled to after you're hurt by someone else's negligence.

Civil Claim or Criminal Claim?

For those who don't spend a lot of time in California courts, and for people who are trying to navigate the sometimes complicated and confusing names and phrases used in court, it can be confusing to know where to begin. One question that injured people often have is whether they need to file a lawsuit, and if so, what kind of lawsuit? Because every case is different, and the costs of going it alone in court can be high (not to mention incredibly confusing for many people), it is advisable to speak with a lawyer who is familiar with the kind of case you have. One basic distinction is between civil cases and criminal cases.

Criminal Cases

If you were injured by someone who intentionally hurt you, for example, the case falls in the criminal realm. This situation typically means the police were involved, and the person who caused the harm was either arrested or cited for criminal behavior. The State of California, through its district attorney offices, will pursue the case against the person who caused the harm. In a very basic sense, this means the state prosecutes the bad actor. 

Criminal/Civil Cases

In some situations, however, the injured person may file a civil claim against the person who hurt them during the crime. Think about O.J. Simpson, for example. The state tried him for murder, for which he was famously found not guilty. But the family of Nicole Brown pursued a civil suit against O.J. Simpson as well. The legal theories involved are not important to understand in depth. Because O.J. Simpson was a wealthy man, if the family prevailed in their lawsuit, the court could enforce the judgment and make sure O.J. paid (or continues to pay, over a long period of time), the money awarded in a verdict. A civil case may also include "punitive" damages, which are meant as a punishment against the wrong actor, as was awarded in the Simpson case.

The O.J. Simpson case is unique, however, in that the money of the civil verdict was actually paid out to the Brown family. What if O.J. was a poor man at the time of the alleged crime, and remained poor throughout the civil trial? The reality is, even if the jury in the civil trial had awarded millions and millions of dollars, in most situations the Brown family would never have seen a penny of it. Which, in real life, means the case would likely never be brought to trial in the first place. Why? Because most lawyers (there are exceptions, but generally speaking) would not take a civil case to trial when there would be almost zero chance of actually ever seeing payment of the money.

There are many situations that call for both a civil and criminal case. For example, if you or someone you love were injured by a drunk driver, the State of California may pursue the drunk driver in criminal court in order to protect the public. However, the criminal case is about the state taking a dangerous individual off the roads, and possibly putting him or her behind bars. But what about the person or people who were injured by the drunk driver? In order to be compensated, they would need to pursue the drunk driver in a negligence claim, or in civil court. Of course, the issue of who would end up paying arises, and unlike the O.J. Simpson example, the drunk driver, if he had insurance, would be covered for this very situation. Thus, the injured person could open a claim with the drunk driver's insurance company and, if navigated correctly, could resolve this issue without ever having to go to court, and could receive to maximum amount of money the insurance policy covered the drunk driver for.

Civil Cases

In the previous example of the drunk driver who injured someone, there is a common misconception that the injured person must wait for the criminal proceeding to finish. This is not accurate. By contacting an injury law firm in California that handles these hybrid cases, the injured person or persons can move forward with their claim with the at-fault driver's insurance company. A good injury attorney will be able to finalize this portion often before the criminal case is even underway. This is, it should be clear, a very general description of how a situation like this example might be handled, and anyone who was injured or who has loved ones who were injured by a drunk driver should not rely on this post for legal advice; they should immediately contact a lawyer or law firm for legal counsel. 

So, Which Case to File?

The reality is, if your situation calls for a criminal proceeding, the police will handle it. If the police aren't aware of what happened, they need to be. Once the police are aware of a criminal act that resulted in injury, a report and investigation will commence, and they will handle it from there. In the civil arena, an experienced and skilled injury law firm may be able to get to the bottom of your case before ever filing a lawsuit. Lawsuits take a lot of time, cost a lot of money, and after all that, don't guarantee that the injured person will recover any more money than if the case settles out of court in the pre-litigation phase. For this reason, an injury attorney may be able to give you an evaluation that will at a bare minimum help you understand where your case or claim stands, and what the possible scenarios are in the future. If you're lucky, you won't ever have to file a lawsuit or step foot in a courtroom, and you'll still end up with the same result as if you had.

Injury Lawyers

The Lions Injury Lawyers P.C. are located in Orange County (OC) California, and help injured persons throughout the State of California. They offer free case evaluations by an attorney. That means you'll be speaking with an actual lawyer, not a salesman who is paid to sign up your case and won't hear a thing about it the day after he signs you up. Don't live in Orange County, or your case didn't happen in Southern California or OC? No problem. The Lions represent clients throughout the state of California, and their handling of your claim won't differ a bit from if you lived right down the street in Irvine, Newport Beach, or Costa Mesa. A brief phone call with an experienced injury attorney will give you peace of mind, and help you look at your situation from a new perspective. The Lions Injury Lawyers can compare your case with thousands of cases in the past, which allows them to estimate how many variables will play out for you. The contents of this blog post are for information purposes only, and should not be relied upon as legal counsel for your case or claim, or for anyone looking for legal advice. The contents of this blog post are intended to educate people, not as legal counsel.

"You Don't Need an Attorney for Your Car Crash Injury Claim"

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For personal injury attorneys in California who practice exclusively injury law, it is only a matter of time before they take a case where the client was told at one point by someone at an insurance company that they didn't need an attorney to help them. The longer injury lawyers practice, the more frequent this story becomes. Clients are told shortly after their car accident by the other driver's insurance company that they "don't need a lawyer for this kind of claim." Because this advice has drastic consequences, a brief look as to why an employee of an insurance company, especially an injury claim adjuster, would say this is worth looking into.

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What Do Insurance Adjusters Do?

Insurance adjusters evaluate claims and, if necessary, offer money to settle the claim. What does "settlement" entail? It basically means that in exchange for money, the claimant will not sue the insurance company's insured in a court of law. This all happens before any lawsuit is filed against the person who caused a crash. Insurance adjusters are therefore middlemen that are supposed to protect the interests of their insured. The more claims an adjuster can settle or close, the better they are at their job in the eyes of their bosses, and they are often compensated accordingly. In short, if an insurance adjuster can get you to settle your claim, they win, and personally it is good for their careers.

What Exactly Does "Evaluate Claims" Mean?

Insurance adjusters evaluate claims. Basically this means they investigate what the claimant is saying in comparison to what their insured says. However, their evaluation is not objective, whereas a jury evaluation of a case is supposed to be objective. If the insurance adjuster's client/insured says they didn't cause the accident, the insurance adjuster will stick by their client, regardless of what the facts say. This means they can deny your claim, even though there's a lot of evidence to show that their guy is at fault. So even though they are tasked with evaluating the claim and trying to get the claimant to go away, their view favors the interests of their company.

Why Don't Adjusters Want Me to Speak With an Attorney?

First, remember that insurance adjusters are expected to move files off their desks. The quicker they can get rid of your file, the sooner they can move on to the next file, and so on. The involvement of an attorney does not necessarily mean your claim will go unsettled longer, but it most certainly means that when your claim settles, it will be for more money. Injury attorneys specialize in getting their clients money, plain and simple. The money comes from the at fault party's insurance company. In short, if an attorney is involved, the insurance company is going to have to pay more money to make the claim go away. This is bad for the individual insurance adjuster's performance metrics.

Insurance adjusters also handle so many car crash cases that they become accustomed to getting their way with plaintiffs who are not represented by an injury lawyer. They get used to having the upper hand in the negotiation, and they are used to getting their way. They also know that the tables turn when an injury law firm is involved, as an experienced injury lawyer will know far more about the law, case results, and how the courts actually work.

The Insurance Company says ________________. Is this true?

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Insurance adjusters are not bad people, but they do have often have a narrow perspective as to how an injury case might play out if an attorney is involved. Again, they settle so many cases for pennies on the dollar that they don't realize a case they settle for $500 may be worth $15,000 or $50,000 if an attorney is involved. They view themselves at injury authorities, even though they are not trained in the law, and don't know what happens to cases that they don't settle that end up in litigation and going to trial. Insurance adjusters therefore often try to coach claimants as to how the process works, even though their approach is heavily favorable to the insurance company's bottom line, and geared towards low settlement.

"My Adjuster is Very Friendly. I Don't Want to Cause Problems for Anyone."

Friendliness is a proven negotiating tactic that is taught to insurance adjusters in most insurance companies. Hint: if you've seen a commercial on television for an insurance company, you can rest assured the adjusters for those companies have all been trained how to present themselves in a friendly manner during negotiations with claimants. Also, remember that none of this is personal. You will never meet the insurance adjuster, and even in the event that your case requires a lawsuit be filed, you will probably never see the individual who injured you again. The insurance policy is there to protect you in the event of injury, and so when you are injured by someone else's careless or reckless driving, the law has provided a way for you to recover, physically and financially. 

If you pursue your claim, it is extremely unlikely that the actual individual who hit you will know or care how much their insurance company settles for. For example, an auto insurance policy for $50,000 covers your injuries up to that amount. Whether you settle for $500 or $50,000, it does not affect the person who injured you personally, as the money comes from the insurance agency. This is why we pay insurance premiums. Every month, every California driver pays money to be insured. In return, if they cause an accident and hurt someone, that money is used to protect the negligent person. Thus, your efforts to get a fair settlement and have your medical bills and pain and suffering paid for have nothing to do with the individual who hit you, but become the responsibility of the insurance company to resolve.

Isn't All This Overly Skeptical of Insurance Companies?

The more injury claims an attorney sees, the more aware he or she is of the many ways in which insurance adjusters are able to convince injured people to do things that will ultimately result in the claimant receiving less money. Insurance companies are insanely profitable, as evidenced by their high profile advertising campaigns, the stadiums their brands are on, and their pervasive presence in advertising culture. Insurance companies spend billions of dollars every year in advertising, and in return, they earn billions of dollars in profits. If you are injured and want to get your medical bills paid for, that is why the insurance policy exists, and why California law requires drivers to have insurance. Insurance companies employ good people, and are not necessarily corrupt, but they do have a bias, and that is to settle all claims for as little money as possible, as this is how they stay profitable.

If You Are Injured

California law provides for full recovery if you were injured, meaning you should be in the same position you were after the car accident or other injury-causing accident as you were before the accident. If your injury is long-lasting, catastrophic, or permanent, this may not be possible. Still, the law makes sure the negligent/at fault person is responsible for making you whole, so if you can't be put back together, you are owed money for pain and suffering. The Lions Injury Lawyers are passionate about getting fair value for injury claims. They fight endlessly to recover as much money as possible for their clients, which will cover all medical expenses and also include money for pain and suffering, lost wages from time off work, and money for other incidental and inconvenient or painful lifestyle changes. The Lions Injury Lawyers spend 100% of their time practicing injury law, and are exclusively dedicated to personal injury clients. Speak with an actual injury attorney today to make sure you're not being taken advantage of as you seek to settle your claim.