Every PI lien case moves through the same six phases. The clinical work is only one piece — the legal, billing, and disbursement steps determine whether you actually get paid and how long it takes. Here's the full timeline, phase by phase, with the doctor's job at each step.
1
Phase 1 · Day 1–7
Patient Intake & Lien Signing
Patient is referred by a PI attorney or arrives self-referred after an accident
Front desk collects accident date, attorney info, police report, and insurance details on the intake form
You evaluate case merit and decide to accept on a lien (or refer out)
Patient signs lien & assignment, LOP, HIPAA, and authorization to release records to attorney
Attorney countersigns the lien within 5–7 days — do not start non-emergent treatment until you have it back
Case is opened in your tracking system with attorney name, claim number, and date of loss
2
Phase 2 · Weeks 1 – 6 months
Treatment Phase
Deliver care on a normal clinical schedule — exam, imaging, therapy, injections, surgery as indicated
Document every visit with ICD-10 and CPT codes and clear causation language tying findings to the accident
Bill at full UCR — do not apply insurance contractual adjustments
Send the attorney a status update every 30–60 days with current charges and treatment plan
Track the running lien balance so you and the attorney always have the same number
3
Phase 3 · 1–2 weeks after MMI
Discharge & Final Narrative Report
Discharge the patient at maximum medical improvement (MMI) with a clear final note
Generate the final itemized bill with all dates of service, CPT codes, and total at UCR
Write a 2–3 page narrative report: history, causation, treatment summary, prognosis, future care needs
Send the final bill, narrative, and complete records to the attorney within 14 days
This package is what the attorney's demand letter is built on — the stronger it is, the higher the settlement
4
Phase 4 · Months 6–12
Attorney Demand Letter to Insurance
Attorney drafts a demand letter packaging your records, bills, narrative, and damages
Demand is sent to the at-fault insurance carrier with a specific dollar number and a 30-day response window
Adjuster reviews, may request additional records, and counters with an offer (often 30–50% of demand)
Attorney and adjuster trade offers — typically 2–4 rounds over 60–120 days
If no agreement is reached, the attorney files suit and the case enters litigation (adds 12–24+ months)
5
Phase 5 · Weeks to months
Settlement Negotiation & Lien Reduction Requests
Once a settlement number is agreed, the attorney calculates net to client after fees, costs, and liens
If the math doesn't work, the attorney calls each lien holder asking for a reduction — this is normal, not adversarial
Review the full disbursement math (total settlement, attorney fee, costs, other liens) before agreeing
Negotiate in writing — typical reductions are 20–40% off billed charges depending on policy limits
Confirm final agreed amount in writing and ask the firm to attach your reduction letter to the closing file
6
Phase 6 · 2–8 weeks post-settlement
Settlement, Disbursement, and Your Check
Patient signs the release; insurance carrier wires settlement funds to the attorney's IOLTA trust account (usually 2–4 weeks)
Attorney prepares a disbursement statement showing every payee and amount
Funds are paid out: attorney fees, case costs, statutory liens (Medicare/Medicaid first), then medical liens, then client
Your check is mailed or sent via electronic disbursement — providers on electronic rails get paid 2–3 weeks faster
Reconcile against the agreed reduction amount and close the case in your tracking system
Realistic Total Timeline by Case Type
Total cycle time varies massively by injury severity and whether the case goes into litigation. Here's what to budget for based on the kind of cases your practice sees most often.
| Case type | Total time to your check | Notes |
|---|---|---|
| Soft tissue (chiropractic, PT, no imaging) | 6–12 months | Quickest cases, lower settlement values, smaller liens |
| Soft tissue + imaging / injections | 9–15 months | Most common PI lien case profile |
| Surgical (ortho, spine, pain mgmt) | 12–24 months | Higher liens, more reduction pressure if policy limits are low |
| Disputed liability / litigation | 24–48 months | Top 25% of cases — plan working capital accordingly |
| Catastrophic / TBI / multi-defendant | 36–60+ months | Largest payouts but longest carry — track every quarter |
Where Disbo cuts the most time
The post-settlement window (Phase 6) is where electronic disbursement saves the most weeks — providers on Disbo typically receive funds 2–3 weeks faster than mailed checks, with real-time visibility from the moment a case settles. See how it works →