New York State Bar Association
Committee on Professional Ethics
Opinion #121-10/30/69 (25-69)
Topic: Attorney signing medical lien
Digest: Not unethical for a lawyer to sign medical lien form
May an attorney sigh the medical lien form quoted below or any assignment or lien form in favor of a doctor?
Patient’s Name: _____________________________
To: Attorney__________________________________ For Doctor _________________________________
I do hereby authorize the above doctor to furnish you, my attorney, or any substitute attorney , with a full report of his examination, diagnosis , prognosis, etc., of myself in regard to the accident in which I was involved.
I hereby authorize and direct you, my attorney, or any substitute attorney, to pay directly to said doctor such sums as may be due and owing him for medical service rendered me both by reason of this accident and by reason of any other bills that are due his office and to withhold such sums from any settlement , judgment or verdict as may be necessary to adequately protect said doctor. I hereby further give a lien on my case to said doctor against any and all proceeds of any settlement , judgment or verdict which may be paid to you, my attorney, or any substitute attorney, or myself as the result of the injuries for which I have been treated or injuries in connection therewith.
I fully understand that I am directly and fully responsible to said doctor for all medical bills submitted by him for services rendered me and this agreement is made solely for said doctor’s additional protection and in consideration of his waiting for payment. I further understand that such payment is not contingent on any settlement, judgment or verdict by which I may eventually recover said fee.
Dated: ____________________________ Patient’s Signature: ______________________________
The undersigned being attorney of record for the above patient does hereby agree to observe all the terms of the above and agrees to withhold such sums from any settlement, judgment or verdict as may be necessary to adequately protect said doctor above named and I further agree and assume pyament of said lien in the event of a substitution of attorneys.
Dated:___________________________ A t t o r n e y ‘ s Signature _____________________________
In the opinion of the Committee there is nothing unethical or improper about an attorney signing the quoted form or any lien form in substantiallly the same terms, assuming the client is made to understand that the attorney is in no way representing the doctor. This opinion is not intended to recommend the use of this or any form of lien assignment or the advisability of signing it by any attorney .