When a chiropractor agrees to treat an injured patient after a car crash or other accident without requiring payment up front, that medical provider is taking on substantial risk. It is important to know about the tools provided by Colorado law which gives chiropractors a way to mitigate this risk – the health-care provider lien.
When properly executed, a medical lien protects the chiropractor’s right to be paid directly from the patient’s personal injury settlement or judgment. When done incorrectly, the lien may be not only be unenforceable but may also leave you stuck with an unpaid bill.
This article explains how Colorado chiropractors and other medical providers can create, perfect, and protect valid liens under current Colorado law.
What Is a Colorado Health-Care Provider Lien?
A health care provider lien is a legal claim placed by a medical provider on a patient’s personal injury claim. It ensures that chiropractors and other medical providers can be paid for their services if they treat patients who are unable to pay upfront from the patient’s civil claim.
Colorado’s Health-Care Provider Lien Act, codified at C.R.S. §§ 38-27.5-101 et seq. (updated by SB19-217 and HB21-1300), allows health-care providers—including chiropractors—to assert a lien against a patient’s recovery from:
- Personal injury claims;
- Wrongful death claims;
- Uninsured motorist (UM) claims; and
- Underinsured motorist (UIM) claims.
- Complex motor vehicle accident claims
The purpose of the statute is to encourage providers to treat injured patients who may not have the ability to pay up front while protecting those patients from abusive lien practices.
How Do I Place a Lien On A Patient’s Claim?
In order to ensure that your lien is enforceable, you must comply with the Colorado Health Care Provider Lien Act.
While there are multiple steps, compliance is actually fairly simple and straight-forward.
Step 1: Use a Compliant Written Lien Agreement
The patient must review and sign the medical provider’s lien agreement.
But simply having the patient sign a “doctor’s lien” form is no longer enough.
Colorado law requires that the medical provider must make specific disclosures to the patient before a health-care provider lien is signed.
Required Disclosures Under C.R.S. § 38-27.5-104
Before the lien is created, the patient must be informed of:
- Available payment options, including:
- Treating on a lien;
- Using health insurance;
- Other agreed payment arrangements;
- The fact that the provider or assignee is not a health insurer;
- That if the patient recovers nothing from their personal injury case, they generally owe nothing (absent fraud or misrepresentation);
- That if the net recovery from the personal injury matter is less than the lien amount, the patient is not liable beyond the net recovery;
- That the lien may not be assigned to a collection agency or debt collector;
- Any common ownership interests involving the provider, lien assignee, or patient’s counsel; and
- That future care may be billed to health insurance if the patient obtains insurance later.
Practice Tip
Hire an attorney to draft a lien agreement specifically updated for Colorado’s post-2021 statute. Many older forms circulating online are no longer compliant.
Step 2: Keep Detailed, Itemized Billing Records
Upon request by the patient or the patient’s attorney, the lien holder must provide an itemized statement of charges.
The final statement should include:
- Dates of service;
- CPT codes;
- Charges for each service;
- Total lien amount; and
- Summary of treatment provided.
Practice Tip
Well-organized records and quick responses to requests make attorneys much more comfortable referring clients to your office and often lead to faster payment.
Step 3: Ensure Charges Reflect Usual and Customary Billed Rates
A health-care provider lien is limited to the provider’s usual and customary billed charges.
This mean that the law prohibits the lien from including:
- Finance charges;
- Interest;
- Artificial markups;
- Inflated “lien rates” that exceed customary charges.
Practice Tip
Your lien amount should match the same rates you ordinarily bill in your practice.
Step 4: File the Lien with the Colorado Secretary of State (Optional but Highly Recommended)
Colorado law makes filing optional, but filing with the Secretary of State can be critical.
Under C.R.S. § 38-27.5-108, providers may file a record of their lien under the Colorado Statutory Lien Registration Act.
Why Filing Matters
If multiple providers have liens, priority is determined as follows:
- Attorneys’ liens come first.
- Filed provider liens have priority over unfiled liens.
- Among filed liens, priority is based on the filing date—first filed, first paid.
Practice Tip
If you are treating a patient with substantial injuries and a potentially limited settlement, filing your lien can materially improve your chances of being paid.
Step 5: Notify the Personal Injury Attorney
Once the lien is signed, send the attorney:
- The signed lien agreement;
- Your itemized billing ledger;
- Relevant treatment notes if requested;
- Any Secretary of State filing confirmation.
Why This Matters
Most plaintiff’s attorneys want to honor valid liens, but they need complete documentation to do so. Remember, the attorney has a fiduciary duty to his/her client to act in the client’s best interest, so any failure to provide complete documentation may allow the attorney to disregard the lien.
Providers who communicate clearly and professionally tend to be paid faster and receive more referrals.
Step 6: Monitor the Case
It is advisable that the provider checks in with the attorney every few months.
Appropriate questions include:
- Is treatment documentation complete?
- Is additional information needed?
- Is the case nearing settlement?
Practice Tip
Polite, periodic follow-up keeps your lien on the attorney’s radar without becoming intrusive.
Step 7: Be Reasonable in Settlement Negotiations
There are a multitude of reasons that many personal injury cases settle for less than the total damages, sometimes even for less than the total medical bills.
As a practical matter, providers are often asked to reduce their liens when:
- Liability is disputed;
- Insurance coverage is limited;
- Significant attorney fees and costs reduce the recovery.
Cooperating with the patient’s attorney can often net you the highest possible payment. If an agreement can’t be reached, courts may get involved, and they may order reductions higher than would have been reasonably negotiated.
However, it is important to note that Colorado law provides that, absent fraud or misrepresentation:
- If the patient recovers nothing, the patient generally owes nothing.
- If the patient’s net recovery is less than the lien, the patient is not liable beyond the amount recovered.
Practice Tip
Reasonable reductions build long-term relationships with attorneys who will continue sending clients to your office. Oftentimes, even with a reduction, the provider may still collect more from the lien than they would have from a health insurer.
Common Mistakes That Can Invalidate a Chiropractor’s Lien
Chiropractors most often run into trouble when they:
- Use outdated lien forms;
- Fail to provide required disclosures;
- Charge above usual and customary rates;
- Add interest or finance charges;
- Refuse to provide itemized statements;
- Ignore requests to reduce liens in low-policy-limit cases.
A court may determine that some or all of a lien is invalid if the provider knowingly fails to comply with the statute.
Remember: Attorneys’ Liens Take Priority
Colorado attorneys have a statutory charging lien under C.R.S. § 13-93-114, and that lien is senior to health-care provider liens.
This means providers should expect attorney fees and litigation costs to be paid before medical liens.
Why Plaintiff’s Attorneys Value Chiropractors Who Understand Liens
The chiropractors who receive the most referrals are those who:
- Use legally compliant lien forms;
- Maintain thorough records;
- Communicate promptly;
- Understand the economics of PI settlements;
- Negotiate fairly when necessary.
When a chiropractor is organized and practical, they become an indispensable part of the plaintiff’s litigation team.
How Our Firm Helps Protect Chiropractic Liens
At Black, Blink, & Associates LLC, we look for chiropractors who will provide the best medical treatment to our clients AND who understand Colorado lien law, thereby making it that much easier to resolve our client’s claims.
We:
- Verify lien compliance early in the case;
- Maintain regular communication with providers;
- Preserve lien priority issues;
- Negotiate reductions only when necessary;
- Ensure providers are paid promptly upon settlement.
We have two simple goals:
- Get the highest legally available settlement for our clients; and
- Treat our provider partners with the same professionalism and respect they show our clients.
Final Thoughts
Colorado’s Health-Care Provider Lien Act gives chiropractors a powerful mechanism to secure payment for treating injured patients. But strict compliance matters.
The chiropractors who understand the law, maintain proper documentation, and work collaboratively with experienced personal injury counsel put themselves in the strongest position to be paid—and to become trusted referral partners.
For questions or referrals, call Black, Blink, & Associates LLC 719-694-0578.
Sources
This article is for informational purposes only and does not constitute legal advice. Providers should consult qualified Colorado counsel regarding specific lien issues