Disclaimer

This article is for educational purposes only and is not legal advice. For advice about your specific situation, consult a licensed attorney in Hawaii.

Detailed answer

What treating on a lien or with a letter of protection (LOP) means

When a medical provider agrees to treat you “on a lien” or accepts a letter of protection (LOP), the provider agrees to delay billing you personally and instead seek payment from any recovery you obtain from a personal injury claim (settlement or judgment). The arrangement is a contract between you and the provider (often coordinated through your attorney). If you do not recover money, the provider may still try to collect from you unless the agreement states otherwise.

How this commonly works in Hawaii

In Hawaii, as elsewhere, medical providers may accept LOPs or other lien arrangements, but they are not required to do so. Hospitals, specialists, chiropractors, and physical therapists vary in their willingness to accept LOPs and in the terms they require. Providers who accept them usually expect a written agreement that explains how they will be paid from any recovery and what happens if there is no recovery.

Steps to find a doctor or facility that will treat you on a lien or LOP

1. Talk to a personal injury attorney first. Many providers will only accept an LOP if they get it from an attorney. An attorney can (a) issue a standard LOP, (b) negotiate payment terms with providers, and (c) explain how a lien would be handled in your case. You can find Hawaii attorneys through the Hawaii State Bar Association or local lawyer referral services (see links below).
2. Ask your treating emergency or primary-care provider. If you already have a treating facility (ER, urgent care, or primary doctor), ask their billing or patient financial services whether they accept LOPs or will place a lien on a settlement. Hospitals often have formal policies, and some will accept a lien only under certain conditions.
3. Contact clinics that commonly work with injury cases. Some orthopedic surgeons, chiropractors, pain-management clinics, and physical therapy practices routinely work with personal injury patients and are more likely to accept LOPs. Calling the clinic’s billing office and asking directly saves time.
4. Use attorney and provider referrals. Attorneys who practice personal injury in Hawaii frequently have lists of providers who accept LOPs. If you can’t hire an attorney immediately, a consultation or a referral call may still help identify willing providers.
5. Consider community health centers and charity care. If you cannot find a provider who will accept a lien and you have limited funds, community health centers and hospital financial assistance programs can provide care or reduced fees. This is separate from LOPs but can bridge care until your case resolves.
6. Verify Medicare/Medicaid and health-insurance rules. If you have Medicare, Medicaid, or private health insurance, those programs have statutory rights to repayment from a settlement (subrogation/conditional payment). Inform any provider and your attorney about these payors so Medicare/Medicaid rules are handled correctly.

What to get in writing

Whenever a provider agrees to treat you on a lien or with an LOP, get a written agreement that states at minimum:

• That the provider will delay billing you personally and look to the injury recovery for payment;
• How much the provider will charge or the method for calculating fees;
• What percentage or amount the provider will take from your recovery (if agreed);
• Whether the provider will attempt to collect from you if there is no recovery and any time limits; and
• Whether the provider will file a lien or other claim against the settlement and how it will be perfected.

Risks and practical considerations

Understand these key risks:

• No guaranteed payment: A provider who accepts a lien is taking a financial risk. If you recover little or nothing, the provider might pursue you personally unless the agreement waives that right.
• Priority of payment: Settlement funds are usually split among medical liens, attorney fees, and other claimants. Ask how the provider expects to be paid and whether they will negotiate their bill with your attorney.
• Insurance and government programs: Medicare and Medicaid have rights to be repaid from settlements and can require immediate notification and repayment procedures. Failing to address these can reduce your net recovery and create penalties.
• Documentation: Keep all medical records, bills, and copies of any lien or LOP. Your attorney will need them to resolve payment issues with the provider and insurers.

Enforcement and filing a lien

Health-care providers sometimes use contract rights, equitable remedies, or state lien statutes (if applicable) to secure payment. The specific procedure and enforceability depend on the provider’s agreement and applicable law. If you have questions about how a lien would be filed or enforced in Hawaii, ask your attorney to explain the local process and any relevant statutes or case law. For a place to look up Hawaii statutes and rules, use the Hawaii State Legislature website.

Where to get help in Hawaii

• Hawaii State Bar Association lawyer referral: https://hsba.org/
• Hawaii State Judiciary — self-help resources and forms: https://www.courts.state.hi.us/self-help
• Hawaii State Legislature (statute search): https://www.capitol.hawaii.gov/
• Centers for Medicare & Medicaid Services (information on Medicare recovery/subrogation): https://www.cms.gov/

Helpful hints

• Before you accept treatment, ask whether the provider accepts liens or LOPs and request the exact written terms.
• Get a free or low-cost consultation with a Hawaii personal injury attorney to learn whether an LOP is appropriate for your case.
• Tell the provider and your attorney if you have Medicare, Medicaid, or other health insurance—these programs have repayment rules that affect liens and settlements.
• Keep copies of every medical bill, record, LOP, and correspondence about payment; these documents matter at settlement.
• Negotiate where possible: many providers will discount billed amounts if they expect only a partial recovery.
• If a provider threatens collection despite an LOP, get an attorney involved quickly to avoid actions that could harm your claim or credit.
• Use community clinics and hospital financial assistance if you cannot find a provider who will accept a lien and you need immediate care.