Medical Liens Under I.C. § 45-704B Are “Extraordinary Collection Actions”:
Commentary on DeKlotz v. NS Support, LLC, 174 Idaho ___ (2025)

1. Introduction

In DeKlotz v. NS Support, LLC the Idaho Supreme Court squarely confronted the intersection between two statutes that had never before been judicially harmonised:

• I.C. § 45-704B – the 1979 medical-lien statute that lets physicians lien an injured patient’s legal claims in order to secure payment; and
• The 2020 Idaho Patient Act (IPA) – omnibus legislation regulating “fair collection of debts owed to health-care providers.”

When neurosurgeon Dr. Paul Montalbano filed a $183,829.60 lien against Guy DeKlotz’s third-party tort claim without first billing the patient’s health insurer, the district court held the lien was outside the IPA’s reach. The Supreme Court reversed, holding that any medical lien filed under § 45-704B is an “extraordinary collection action” (ECA) within the meaning of the IPA, thereby requiring the provider to satisfy the Act’s pre-collection conditions.

The decision not only invalidated Montalbano’s lien but also created a precedent that reshapes Idaho’s medical-debt landscape, at least until the 2024 statutory amendments take full effect.

2. Summary of the Judgment

1. Holding #1 – Statutory Classification: A medical lien placed on a patient’s chose-in-action is “placing a lien on a person’s property or assets” and therefore an ECA under I.C. § 48-303(3)(c).
2. Holding #2 – Debt Connection: Because the patient-payment contract made DeKlotz ultimately liable for the bill, the lien was “in connection with a patient’s debt,” satisfying the second ECA element.
3. Holding #3 – Consequence of Non-Compliance: Failure to bill the patient’s health insurer within 45 days (I.C. § 48-304(1)(a)) renders any ensuing ECA—including a lien—void.
4. Disposition: Reversed; judgment vacated; lien declared invalid; case remanded for entry of declaratory relief and determination of trial-level attorney fees. Appellant awarded fees on appeal under I.C. § 48-305(3).

3. Detailed Analysis

3.1 Precedents Cited and Their Influence

• Rose v. Martino, ___ Idaho ___ (2025) and Owen v. Smith, 168 Idaho 633 (2021) – reiterated the Court’s summary-judgment standard, ensuring de novo review of the legal question.
• Angelos v. Schatzel, 174 Idaho 426 (2024) & Muir v. City of Pocatello, 36 Idaho 532 (1922) – both confirmed that a cause of action for personal injury is property, thus allowing the lien to be characterised as attaching to “property or assets.”
• Wheeler v. Idaho Dep’t of Health & Welfare, 147 Idaho 257 (2009) – supplied the interpretive canon that clear, unambiguous text controls.
• Sweitzer v. Dean, 118 Idaho 568 (1990) – the Court acknowledged the mandate to harmonise statutes “where possible,” but relied on Wheeler when it found harmonisation impossible.
• Chavez v. Barrus, 146 Idaho 212 (2008) – used for the definitional proposition that a lien is “a charge upon property to secure payment of a debt,” strengthening the “debt” nexus.

3.2 The Court’s Legal Reasoning

1. Plain-Meaning Approach: The Court began with the IPA’s explicit definition of an ECA: “placing a lien on a person’s property or assets.” Because § 45-704B liens fit that description, no further interpretive gymnastics were warranted.
2. Two-Part ECA Test Satisfied:
   • (i) An action enumerated – the lien itself; and
   • (ii) “In connection with a patient’s debt” – evidenced by the signed payment contract and general lien doctrine.
3. Rejection of Implied Exception: The Court refused to create a judicial safe-harbour for § 45-704B liens because the legislature could (and in 2024 did) amend the statutes directly.
4. Practical Impossibility ≠ Ambiguity: Although acknowledging that concurrent compliance with both time-lines (45 days to bill insurance vs. 90 days to record a lien) was “difficult, if not practically impossible,” the Court held that policy hardships belong to the legislature, not the judiciary.
5. Automatic Invalidity: Once classified as an invalid ECA, the lien could not be salvaged by equitable doctrines; § 48-304 is explicit.

3.3 Impact of the Decision

• Immediate Effect: All pre-2024 medical liens filed without IPA compliance are vulnerable to collateral attack and declaratory suits.
• Provider Behaviour: Physicians must now sequence their billing and collection efforts carefully—at least for claims predating the 2024 amendments—to avoid lien invalidation and fee exposure.
• Litigation Strategy: Personal-injury plaintiffs can deploy declaratory actions under the IPA both offensively (to clear title to their cause of action) and defensively (to mitigate settlement pressure from large liens).
• Statutory Amendments: The Court footnoted that the 2024 legislature “specifically address[ed] the applicability of the IPA to medical liens,” implicitly inviting future litigants to test the new framework while cementing the rule for the 2020–2024 window.
• Attorney-Fee Leverage: Section 48-305(3) proved potent; prevailing patients recover full fees, incentivising challenges to non-compliant medical collections.

4. Complex Concepts Simplified

Extraordinary Collection Action (ECA)

Any aggressive legal tactic—e.g., liens, garnishments, civil suits—used by a provider to collect a medical debt. ECAs are barred unless strict IPA prerequisites are met.

Medical Lien (I.C. § 45-704B)

A statutory security interest allowing physicians to attach an injured patient’s tort claim up to the “reasonable charges” for care rendered.

Chose-in-Action

A personal right to sue; recognised as intangible property under Idaho law.

Contested Judgment (IPA)

A court action in which the defendant appears or otherwise challenges the claim, making an award of patient attorney fees mandatory if the patient prevails.

Plain-Meaning Rule

Judicial doctrine that unambiguous statutory language must be applied as written, even if the result is harsh or anomalous.

5. Conclusion

DeKlotz v. NS Support, LLC is a textbook example of statutory collision and judicial triage. By refusing to carve out § 45-704B liens from the ambit of the Idaho Patient Act, the Supreme Court confirmed that form (lien) cannot trump substance (debt collection). The ruling invalidated the lien in question, awarded fees to the patient, and signalled a new compliance paradigm for Idaho health-care providers—at least for the pre-2024 statutory regime.

Going forward, counsel on both sides of medical-debt disputes must map their strategy around the detailed IPA timeline and the newly amended lien statutes. Until appellate courts interpret the 2024 revisions, the DeKlotz precedent governs all legacy liens and supplies persuasive authority on the broad reach of “extraordinary collection action.” The case thus stands as an important milestone in Idaho’s effort to balance physician reimbursement with patient protection.