(1) If a lien has been satisfied or waived, the practitioner, nurse, hospital, or ambulance service provider that established or waived it shall, on written demand and at the expense of the patient, or the person by whom the patient was injured, or by the insurer obligated by reason of the injury, give a written release acknowledged before a notary public.
(2) Any practitioner, nurse, hospital, or ambulance service provider that refuses or fails under the circumstances stated, for a period of five (5) days or more after a written demand is made for a release, to execute and deliver the release is liable to the demandant for injury or damage that results from refusal or failure.
(3) He or she shall forfeit to the demandant the sum of twenty-five dollars ($25.00), which may be recovered in an action for damages because of the failure, or in a civil action before a court having jurisdiction, as the circumstances of the case require.