The Pebley case, and treating injuries on a lien.

Doctors who treat on a lien in California need to know about the Pebley case. Sometimes, a patient will seek out the best doctor to treat their injuries from car accidents, and the doctor does not take their insurance. In this case, you're essentially uninsured, and you must treat your injuries on a lien if you can't afford to pay the doctor out of pocket.

The Pebley v. Santa Clara Organics, LLC case is an important ruling that can have significant implications for healthcare providers like chiropractors who treat personal injury patients on a lien basis.

The case essentially affirmed that an injured plaintiff who chooses to treat with doctors on a lien basis—as opposed to using their health insurance—should be considered "uninsured" for the purposes of determining recoverable medical expenses. In practice, this means that the "reasonable value" of the medical services could be based on the provider's regular rates, not the discounted rates negotiated by insurance companies.

Here are some key takeaways that might be relevant to your practice:

1. Higher Rates: The decision allows healthcare providers treating on a lien basis to potentially charge higher, customary rates rather than discounted insurance rates.
2. Expert Testimony: The decision also discusses the use of expert testimony to prove up the "reasonable value" of medical services. This could be relevant if you ever find yourself needing to justify your rates in a legal context.
3. Choice of Care: It underscores the plaintiff's right to choose their medical care. If a plaintiff decides not to use their insurance and opts for treatment on a lien basis, their choice should not limit their ability to recover the full "reasonable value" of those services.
4. Potential for Larger Settlements: With the possibility of claiming higher medical expenses as damages, plaintiffs might secure larger settlements or awards, which in turn could mean a larger amount available to satisfy medical liens.
5. Ethical Considerations: While the case provides the possibility of charging higher rates, healthcare providers should still consider the ethical implications and how it affects the patient's portion of a settlement.
6. Contractual Obligations: The ruling doesn't negate any contractual obligations you might have with insurance providers, so you should be cautious in how you apply this decision to your billing practices.

The Pebley case has had a profound impact on personal injury law, offering significant advantages for attorneys handling injury claims. In this landmark decision, the California court affirmed that plaintiffs who seek treatment from out-of-network providers—such as those offering lien-based care—can recover the reasonable cost of their medical treatment, rather than being limited to what they would have paid under their insurance. This ruling allows attorneys to present a broader range of treatment options for their clients without the limitations imposed by insurance networks.

For attorneys, this means that when you represent a client with injuries, you can confidently refer them to lien-based providers, knowing that their full, reasonable medical costs can be recovered as part of the case. This is particularly beneficial when insurance coverage falls short or when the injured party prefers to avoid insurance involvement altogether.

At our chiropractic clinic, we frequently collaborate with attorneys on lien-based treatment plans for personal injury clients. This approach ensures that your clients receive the necessary care—especially for conditions like whiplash or spinal injuries—without upfront payment concerns. The lien arrangement allows us to defer payment until the case resolves, which helps remove financial barriers to essential care.

For healthcare providers, the Pebley decision provides a clear framework for working with lien-based cases, ensuring that out-of-network services are fairly compensated, supporting both patient recovery and successful case outcomes.