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TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING CHAPTER 131 TO TITLE 44 SO AS TO ESTABLISH HEALTH CARE PROVIDER LIENS; TO PROVIDE PROCEDURES UNDER WHICH A HEALTH CARE PROVIDER CAN ESTABLISH A LIEN AGAINST ANY SUM COLLECTED OR TO BE COLLECTED BY A PATIENT WHO WAS TREATED BY THE HEALTH CARE PROVIDER FOR INJURIES DUE TO TORTIOUS CONDUCT; TO PROVIDE PROCEDURES FOR ENFORCING SUCH LIENS; AND TO ADD SECTION 38-71-290 SO AS TO PROVIDE THAT AN INSURED MAY ASSIGN REIMBURSEMENT RIGHTS FOR HEALTH CARE SERVICES DIRECTLY TO THE PROVIDER AND TO FURTHER PROVIDE THAT WHEN SUCH ASSIGNMENT IS AUTHORIZED, THE INSURER SHALL PAY DIRECTLY TO THE PROVIDER THE AMOUNT THE INSURER WOULD HAVE REIMBURSED THE INSURED.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. The 1976 Code is amended by adding:
Section 44-131-100. As used in this chapter:
(1) 'Health care provider' means a chiropractor, physician, physician's assistant, dentist, pharmacist, registered nurse, licensed practical nurse, optometrist, or paramedic.
(2) 'Health care services' means furnishing an individual with medical or dental care or treatment, medical supplies, medications, ambulance services, or any other service rendered by a health care provider intended to improve the physical or mental health of the patient or to prevent, alleviate, cure, or heal human illness resulting from physical or psychological injury.
(3) 'Patient' means a person or persons who receives health care services due to injury resulting from the tortious actions of another party and who is not represented by legal counsel.
(4) 'Release' means a general release of liability, covenant not to sue, or any other agreement by the patient or the patient's representative to discharge from liability or waive enforcement of any judgment against a third party, and includes any such agreement regardless of an admission of liability on behalf of the third party.
(5) 'Third party' means a person, surety, insurance company, or other entity that pays or agrees to pay a sum to the patient as compensation for the personal injury for which the patient received health care services.
Section 44-131-110. (A) A licensed health care provider who furnishes services to a person injured as the result of the negligence or other wrongful act of another person has, subject to the provisions of this chapter, a lien for all reasonable and necessary charges for health care services upon the gross amount payable to the injured person, or his or her heir, assign, or legal representative, out of the total amount of any recovery collected or to be collected, whether by judgment, settlement, or compromise, by the injured person for damages on account of the injury.
(B) A lien arising under this chapter is subordinate to the subrogation interests of the state Medicaid agency pursuant to Section 43-7-440 and the lien created in favor of the Department of Mental Health pursuant to Section 44-23-1140. Otherwise, all liens arising and perfected pursuant to this chapter have equal priority, regardless of the time of the treatment or notice of lien. If the patient recovers an amount from a third party in settlement or discharge of a claim for the injuries for which health care services were provided, and the amount recovered is insufficient to satisfy all liens arising under this chapter, each health care provider asserting a lien is entitled to enforce the lien against the proceeds in the proportion which the health care provider's lien bears to the total amount of all health care liens perfected under this chapter. In no event shall the total amount of all liens, attorneys' fees, and costs exceed two-thirds of the amount recovered from the third party, so that the patient is entitled to receive no less than one-third of the amount paid by the third party, or representative of the third party, after payment of all interests asserted under this chapter. An interested party may bring an action to determine the proper apportionment of the recovery from a third party or representative of the third party among the patient and all health care providers who have asserted a perfected lien pursuant to this chapter.
(C) The provisions of this section do not apply to health care provider charges incurred after the date of a judgment, settlement, or compromise.
Section 44-131-120. (A)(1) A health care provider seeking to perfect a lien pursuant to this chapter shall, no later than ninety days after commencement of the provision of health care services:
(a) give written notice to the patient and the patient's attorney, if any, informing the patient that any sum the patient receives from a third party as compensation for the injuries for which the health care services were provided is subject to a lien under this chapter. Written notice of the lien to the patient by the health care provider, constitutes a perfected lien as a matter of law;
(b) give written notice to the third party, if known by the health care provider, that any sum paid to the patient as compensation or in settlement of claims arising out of the injury for which the patient received health care services is subject to a lien under this chapter;
(c) give written notice to any insurance company or other surety who provides insurance coverage on behalf of the third party, if such insurance company or surety is known by the health care provider, that any sum paid to the patient as compensation or in settlement of claims arising out of the injury for which the patient received health care services is subject to a lien under this chapter; and
(d) provide the patient or their attorney with an itemized statement, any medical report, or other documentation necessary for negotiation, settlement, or trial of the patient's claim.
(2) The written notice required by subsection (A)(1) shall contain, at a minimum:
(a) the name and address of the patient as it appears in the records of the health care provider;
(b) the name and location of the health care provider asserting the lien;
(c) the name and title of the agent or employee of the health care provider responsible for administering the patient's account related to the lien;
(d) the date of the commencement of health care services;
(e) if known to the health care provider, the name and address of any person, firm, corporation, or other entity claimed by the patient to be responsible for the injuries for which health care services where provided.
(B) The lien provided for in this chapter arises regardless of whether the patient executes an assignment to the health care provider of amounts claimed against the third party.
(C) A health care provider who has obtained and perfected a lien pursuant to this chapter may bring an action against the patient to enforce the lien against the proceeds of any sums received from a third party or representative of the third party in settlement or compromise of any claims for damages for the injuries for which health care services where rendered. The action must be brought in the county in which the health care services were provided or in the county in which the patient resides at the time the action is commenced, at the option of the health care provider. If the patient is not a resident of this State, the action must be brought in the county where the health cares services were rendered. A person asserting an interest in the proceeds by virtue of a perfected lien or subrogation right must be joined as a party to the action if available and subject to process. The prevailing party in the action is entitled to recover costs, including a reasonable attorney's fee to be determined by the court. No action to enforce the lien created by this chapter may be brought more than three years after the patient receives any sum from the third party, or representative of the third party, to release all claims.
(D) The remedies provided by this chapter are in addition to other remedies a health care provider may have at law or in equity. Nothing in this chapter may be construed to affect the right of the health care provider to pursue any remedies the health care provider may have at law or in equity against the patient to recover for payment of health care services provided to the patient. The health care provider may pursue his or her remedy pursuant to this chapter without first pursuing an action to collect the amount directly against the patient.
(E) An interested person desiring to contest a lien perfected pursuant to this chapter may seek a declaration as to the validity or amount of any lien asserted under this chapter. The declaration may be sought by intervention into any action already pending for recovery of damages for the injuries giving rise to the health care services or, if no action is pending, by bringing an independent action for declaratory judgment in the county in which the patient received health care services giving rise to the challenged lien or in the county in which the patient resides at the time the action is commenced. If the patient is not a resident of this State, the action must be brought in the county in which the health care services giving rise to the challenged lien were rendered. The court in a nonjury action may then determine the validity of the lien under this chapter.
Section 44-131-130. A lien created and perfected pursuant to this chapter is not affected by any release of liability or cause of action, covenant not to sue, or any other purported discharge or release of the third party, or representative acting on behalf of the third party, unless the health care provider joins in the release, covenant not to sue, or discharge and executes a written release of the lien. The release of lien must contain the information required for notice of lien under Section 44-127-50. If a third party, or representative acting on behalf of the third party, after receiving the notice of lien pursuant to this chapter, pays any amount solely to the patient in order to settle or discharge any claim the patient may have against the third party for the injuries for which health care services where provided, without first obtaining the release of lien required by this section, the health care provider has an independent right of action against the third party, or representative acting on behalf of the third party, to recover an amount equal to the lien. No independent action pursuant to this section may be brought more than three years after the third party, or representative of the third party, has paid the funds directly to the patient."
SECTION 2. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding:
"Section 38-71-290. An insured may assign reimbursement rights for health care services directly to a provider. The insurer, when authorized by its insured, shall pay directly to the provider the amount of the claim, under the same criteria and payment schedule that would have been reimbursed directly to the insured. An insurer making a payment to the insured after the rights to reimbursement have been assigned to the provider is liable to the provider for the payment. A policy of accident or health insurance may not prohibit assignment of benefits or reimbursement to a provider by an insured."
SECTION 3. This act takes effect upon approval by the Governor.
This web page was last updated on Tuesday, June 23, 2009 at 2:27 P.M.