Line 45 of the record
What Is a Medical Lien in a Georgia Accident Settlement and How Do Hospital or Provider Liens Affect the Victim’s Net Recovery?
A Georgia hospital, nursing home, physician practice, chiropractic practice, or traumatic burn care practice can claim a lien on the injured person’s cause of action for its reasonable charges, subject to any attorney’s lien. The lien is valid only with timely notice and filing, and unenforceable unless the provider first billed any health insurer the patient has and was rejected. Health insurers face a separate full-compensation condition.
What the provider lien reaches
Under O.C.G.A. § 44-14-470(b), the lien is “for the reasonable charges” of care and treatment and is “upon any and all causes of action accruing to the person to whom the care was furnished”. It is subject to any attorney’s lien, and a chiropractic lien is also subject to any hospital lien. The statute limits it: it “is only a lien against such causes of action and shall not be a lien against such injured person, such legal representative, or any other property or assets of such persons and shall not be evidence of such person’s failure to pay a debt.”
The conditions that make it valid
| Requirement | What § 44-14-471 says |
|---|---|
| Notice before filing | Written notice to the patient and the parties claimed to be liable, and their insurers, at least 15 days before filing, by first-class and certified mail or statutory overnight delivery, return receipt requested; the notice must state that the lien is not a lien against the patient or the patient's other property |
| Where to file | The clerk of superior court in the county where the provider is located and in the county where the patient lives, if a Georgia resident |
| When to file | Hospital, nursing home, or burn care provider: within 75 days after discharge. Physician or chiropractic practice: within 90 days after the patient first sought treatment for the injury |
| Health insurance first | "No filing of a claim or lien under this part shall be enforceable unless" the provider "first submitted a claim to each health insurer of the injured person, if such injured person has health insurance coverage, and had such claim rejected" |
A lien not perfected by timely notice and filing is invalid, except against a liable party that received actual notice of the notice and filed statement, by hand delivery, certified mail, or statutory overnight delivery, before any release or settlement (§ 44-14-471(b)). Each of these is a fact to check against the provider’s own papers before a lien is paid.
Health insurers: the full-compensation condition
A health insurer, health plan, or other “benefit provider” that paid medical expenses may require reimbursement from a third-party recovery only if “The amount of the recovery exceeds the sum of all economic and noneconomic losses incurred as a result of the injury”, and its claim must be “reduced by the pro rata amount of the attorney’s fees and expenses of litigation” (O.C.G.A. § 33-24-56.1(b)). When the parties dispute whether a settlement made the injured person whole, the benefit provider may seek a declaratory judgment, and “If the court determines said settlement does not fully and completely compensate the injured party, the benefit provider has no right of reimbursement” (§ 33-24-56.1(c)).
Whether a particular plan is governed by this Georgia statute or by federal law depends on the plan, and is a question to answer from the plan documents before negotiating.
Medicare and Medicaid
Federal law treats Medicare as secondary when an “automobile or liability insurance policy or plan” is responsible. A primary plan, and “an entity that receives payment from a primary plan”, must reimburse the Medicare trust fund for payments Medicare made, and a settlement can establish that responsibility “whether or not there is a determination or admission of liability” (42 U.S.C. § 1395y(b)(2)(B)(ii)). A Medicare beneficiary’s settlement therefore has to account for Medicare’s conditional payments.
Georgia’s Medicaid program has its own lien. The Department of Community Health “shall have a lien for the charges for medical care and treatment provided a medical assistance recipient upon any moneys or other property accruing to the recipient” when the injury is “due to the liability of a third party” (O.C.G.A. § 49-4-149(a)). The department perfects it through the hospital lien procedures, with one year from the date the last item of care was furnished to file its verified lien statement, and the lien does not affect the priority of any attorney’s lien (§ 49-4-149(b)).
| Claim on the recovery | What has to be true before it is paid | Where the rule is |
|---|---|---|
| Hospital, nursing home, physician, chiropractic, or burn care lien | Timely notice and filing, and the health insurer billed first and the claim rejected | § 44-14-471 |
| Health insurer or plan under Georgia law | The recovery exceeds all economic and noneconomic losses; the claim is reduced pro rata for fees and expenses | § 33-24-56.1 |
| A plan that may be governed by federal law | The plan documents decide whether the Georgia rule applies | The plan |
| Medicare | Reimbursement of what Medicare paid when a liability policy is responsible | 42 U.S.C. § 1395y(b)(2) |
| Georgia Medicaid | The department's lien, perfected through the hospital lien procedures | § 49-4-149 |
A worked example with a $100,000 settlement
For example, imagine a $100,000 settlement with a one-third attorney fee and $5,000 in case expenses, a hospital lien of $30,000, and a health insurer claim of $12,000:
| Step | Amount |
|---|---|
| Settlement | $100,000 |
| Attorney fee and expenses | $38,333 |
| Hospital lien, if valid under § 44-14-471 | $30,000 |
| Health insurer, only if the recovery exceeds all losses | $0 or a reduced amount |
| To the injured person, before any health insurer payment | $31,667 |
If the injured person’s total losses are $250,000, the $100,000 recovery does not exceed them, and under § 33-24-56.1(b) the health insurer’s reimbursement claim fails. A hospital lien that was never perfected, or filed without first billing the health insurer, may not be payable at all. The figures are invented; whether each claim is owed, and in what amount, depends on that claimant’s own papers and the rules above.
Other claims on the recovery
A workers’ compensation insurer’s lien follows its own full-compensation rule, explained in workers’ compensation and a third-party car accident lawsuit. How health insurance and letters of protection affect what the jury hears about medical bills is covered in Georgia’s collateral source rule.
Before signing a settlement
- Which providers have sent lien notices, and when?
- Was each lien filed in both required counties within 75 or 90 days?
- Did each provider bill your health insurer first, and was the claim rejected?
- Does the recovery exceed all of your economic and noneconomic losses?
- Did Medicare or Medicaid pay any of the bills?
Sources
- O.C.G.A. §§ 44-14-470, 44-14-471 (text as published in March 2024, including the 2023 amendments by Senate Bill 168); § 33-24-56.1 (text as published in March 2024); § 49-4-149 (text as published in March 2024; no amendment listed in the 2017 to 2026 summaries of general statutes enacted).
- 42 U.S.C. § 1395y
This page describes Georgia law as of October 2026 for general information. It is not legal advice and does not create an attorney-client relationship.