Illinois law provides that every health care professional and health care provider that “renders any service in the treatment, care, or maintenance of an injured person,” the care provider may assert a lien against “all claims and causes of action” of the injured person up to the amount of the care provider’s charges.

In the closing days of its November term, the Illinois Supreme Court allowed a petition for leave to appeal in Manago v. County of Cook, a decision from Division Five of the First District which poses several interesting questions for the operation of the Health Care Services Lien Act: (1) does the care provider have to intervene in the personal injury action in order to assert the lien; (2) may a hospital lien be enforced against a minor; and (3) may the lien attach to a judgment that doesn’t include an award for medical expenses?

Manago arises from an accident in August 2005 when the plaintiff – who was at the time a minor – was injured in an elevator accident.  Plaintiff sued various defendants, alleging that they had negligently failed to inspect and maintain the elevator, which was a direct and proximate cause of his injuries.  Subsequently, the plaintiff alleged in his second amended complaint that the defendants had negligently failed to ensure that persons, including the plaintiff himself, would not have access to the elevator roof.

The County mailed a notice of lien to the plaintiff’s attorney in 2009, but the County never formally intervened in the personal injury action.  The action was tried without a jury.  The plaintiff requested various categories of damages, including just under $80,000 to the plaintiff’s mother for “medical bills.”  Ultimately, the trial court declined to award anything to the plaintiff for present or future medical expenses on the grounds that plaintiff’s mother had failed to show that she had any expectation of having to pay any of the plaintiff’s expenses.

In early 2012, the minor plaintiff filed a petition to strike and extinguish the County’s lien.  After hearing argument, the court granted the motion to strike, holding that there was no case law permitting a lien holder to recover after not appearing to protect the lien at trial.

The Appellate Court began by concluding that a lien holder was not required to formally intervene in the personal injury action in order to protect its lien.  The lien holder had served notice on the plaintiff’s attorney, and the tortfeasors had notice of the lien (to the extent that they were entitled to notice) by virtue of their attorneys’ appearance at the hearing on the petition.

The Court then turned to the question of whether a lien could be enforced against a minor.  The court noted that the Act merely refers to an “injured person,” without distinguishing between minors and adults.  The plaintiff argued that as a minor, he could not incur a debt for the medical expenses.  The Appellate Court disagreed, noting that the Supreme Court has held a number of times that a minor’s estate may incur debt or other obligations by operation of law.

But there was a related problem: the Rights of Married Persons Act.  According to Section 15(a)(1) of the Act, “the expenses of the family” are chargeable to the two spouses, not to the children.  Further, it was well established, according to the court, that the relevant “expenses of the family” included the children’s medical expenses.  Accordingly, any cause of action to recover for medical expenses was that of the parent, not the child.  For that reason, the courts have held that an insurer may not enforce a subrogation lien against a minor’s recovery – the minor is not the party who owes the debt.

The Court then turned to the question of whether a lien could attach to a judgment where there was no award of medical expenses.  The Court pointed out that the phrase in the statute “all claims and causes of action of the injured person” is modified and limited by the language “for the amount of the health care professional’s or health care provider’s reasonable charges up to the date of payment of damages to the injured person.”  That language did not merely describe the amount of the lien; it also describes the nature of the claim triggering the creation of the lien.  Since the minor plaintiff’s mother did not assign her cause of action for medical expenses to him, and since the plaintiff was awarded nothing for medical expenses, there was nothing for the lien to attach to.

Justice Gordon specially concurred, arguing that the lien attached to the entire judgment, not just monies awarded for medical expenses, but concluding that the statute was contrary to public policy.  Justice Lampkin dissented, concluding that the defendant had a valid lien.

We expect Manago to be decided in the fall of 2017.

Image courtesy of Flickr by Gideon Tsang (no changes).