Revised Code of Washington
Chapter 43.20B - Revenue Recovery for Department of Social and Health Services.
43.20B.040 - Chapter does not apply where another party liable—Statement of lien—Form.

RCW 43.20B.040
Chapter does not apply where another party liable—Statement of lien—Form.

The form of the lien in RCW 43.20B.060 shall be substantially as follows:
STATEMENT OF LIEN
Notice is hereby given that the State of Washington, Department of Social and Health Services, has rendered assistance or provided residential care to . . . . . ., a person who was injured on or about the . . . . day of . . . . . . in the county of . . . . . . state of . . . . . ., and the said department hereby asserts a lien, to the extent provided in RCW 43.20B.060, for the amount of such assistance or residential care, upon any sum due and owing . . . . . . (name of injured person) from . . . . . ., alleged to have caused the injury, and/or his or her insurer and from any other person or insurer liable for the injury or obligated to compensate the injured person on account of such injuries by contract or otherwise.

 
STATE OF WASHINGTON, DEPARTMENT
 
OF SOCIAL AND HEALTH SERVICES
 
By: . . . . (Title)
STATE OF WASHINGTON

COUNTY OF





ss.
I, . . . . . ., being first duly sworn, on oath state: That I am . . . . . . (title); that I have read the foregoing Statement of Lien, know the contents thereof, and believe the same to be true.
 
. . . .
Signed and sworn to or affirmed before me this . . . . day of . . . . . ., (year) . . . .
 
by . . . .
 
(name of person making statement).
(Seal or stamp)
 
 
. . . .
 
Notary Public in and for the State
 
of Washington
 
My appointment expires: . . . .


[ 2016 c 202 § 33; 1990 c 100 § 3; 1979 c 141 § 341; 1969 ex.s. c 173 § 9. Formerly RCW 74.09.182.]

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Structure Revised Code of Washington

Revised Code of Washington

Title 43 - State Government—Executive

Chapter 43.20B - Revenue Recovery for Department of Social and Health Services.

43.20B.010 - Definitions.

43.20B.020 - Fees for services—Department of health and department of social and health services.

43.20B.030 - Overpayments and debts due the department—Time limit—Write-offs and compromises—Waivers.

43.20B.040 - Chapter does not apply where another party liable—Statement of lien—Form.

43.20B.050 - Liens—Compromise—Settlement or judgment.

43.20B.060 - Reimbursement for medical care or residential care—Lien—Subrogation—Delegation of lien and subrogation rights.

43.20B.070 - Torts committed against recipients of state assistance—Duties of attorney representing recipient—Trust account for departmental lien.

43.20B.080 - Recovery for paid medical assistance—Rules—Disclosure of estate recovery costs, terms, and conditions.

43.20B.090 - Recovery for paid medical assistance and state-funded long-term care—Legislative intent—Legislative confirmation of effect of 1994 c 21.

43.20B.095 - Establishment and recovery of debts for the department of children, youth, and families.

43.20B.110 - License fees to be charged by secretary—Waiver—Review and comment.

43.20B.120 - Funeral assistance—Lien against assets.

43.20B.310 - Residential care payments by families, when not collected.

43.20B.320 - Mental illness—Treatment costs—Criminally insane—Liability.

43.20B.325 - Mental illness—Hospitalization charges—How computed.

43.20B.330 - Mental illness—Treatment costs—Liability.

43.20B.335 - Mental illness—Treatment costs—Determination of ability to pay—Standards—Rules and regulations.

43.20B.340 - Mental illness—Treatment costs—Notice and finding of responsibility—Period—Adjudicative proceedings.

43.20B.345 - Mental illness—Treatment costs—Judgment for accrued amounts.

43.20B.347 - Mental illness—Treatment costs—Lien against real and personal property.

43.20B.350 - Mental illness—Treatment costs—Modification or vacation of findings of responsibility.

43.20B.355 - Mental illness—Hospitalization charges—Due date—Collection.

43.20B.360 - Mental illness—Hospitalization charges—Collection—Statutes of limitation.

43.20B.370 - Mental illness—Hospitalization charges—Collection—Prosecuting attorneys to assist.

43.20B.410 - Residential habilitation centers—Liability for costs of services—Declaration of purpose.

43.20B.415 - State residential schools—Liability for costs of services—Limitation.

43.20B.420 - Residential habilitation centers—Determination of costs of services—Establishment of rates—Collection.

43.20B.425 - Residential habilitation centers—Costs of services—Investigation and determination of ability to pay—Exemptions.

43.20B.430 - Residential habilitation centers—Costs of services—Initial notice and finding of responsibility—Service—Adjudicative proceeding.

43.20B.435 - State residential habilitation centers—Costs of services—Modification or vacation of initial finding of responsibility.

43.20B.440 - Residential habilitation centers—Costs of services—Charges payable in advance.

43.20B.445 - Residential habilitation centers—Costs of services—Reimbursement from property subsequently acquired—Placement outside school—Liability after death of resident.

43.20B.450 - State residential habilitation centers—Costs of services—Liabilities created apply to care, support, and treatment after July 1, 1967.

43.20B.455 - Residential habilitation centers—Costs of services—Discretionary allowance in resident's fund.

43.20B.460 - Guardianship fees and additional costs for incapacitated clients paying part of costs—Maximum amount—Rules.

43.20B.620 - Overpayments of assistance—Lien against recipient's property—Recovery methods.

43.20B.630 - Overpayments of assistance—Procedures—Adjudicative proceeding.

43.20B.635 - Overpayments of assistance—Orders to withhold property of debtor—Procedures.

43.20B.640 - Overpayments of assistance—Failure to withhold property of debtor.

43.20B.645 - Overpayments of assistance—Assignment of earnings.

43.20B.660 - Improper realty transfer—Suit to rescind—Recovery from recipient's estate.

43.20B.670 - Excess property assistance program—Lien—Department as creditor.

43.20B.675 - Vendor overpayments—Goods or services provided on or after July 1, 1998—Notice—Adjudicative proceeding—Enforcement—Collection—Rules.

43.20B.680 - Vendor overpayments—Lien or other security—Setoff or recoupment—Exception.

43.20B.685 - Vendor overpayments—Liens—Duration—Enforcement.

43.20B.688 - Limitation on actions to enforce vendor overpayment debts.

43.20B.690 - Vendor overpayments—Remedies nonexclusive.

43.20B.695 - Vendor overpayments—Interest—Exceptions.

43.20B.710 - Medical assistance—Improper transfer or assignment of resources—Penalty—Presumption, rebuttal—Attorney's fees.

43.20B.720 - Recipient receiving industrial insurance compensation—Subrogation rights of department—Lien—Withhold and deliver notice.

43.20B.730 - Recipient receiving industrial insurance compensation—Effective date of lien and notice—Service.

43.20B.735 - Recipient receiving industrial insurance compensation—Duty to withhold and deliver—Amount.

43.20B.740 - Recipient receiving industrial insurance compensation—Adjudicative proceeding—Collection pending final order.

43.20B.745 - Recipient receiving industrial insurance compensation—Application.

43.20B.750 - Recipients holding title to real property or purchasing under land sales contracts—Recording request for notice or termination or request for notice of transfer or encumbrance of property—Notice and hearing—Rules.

43.20B.900 - Savings—1987 c 75.

43.20B.902 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.