Short Answer

In North Carolina, your attorney’s fee comes off the top of the settlement. From the remainder, perfected medical provider liens can take no more than 50% in total, and they share that amount pro rata. Some payors (for example, Medicare and the State Health Plan) have separate repayment rules that aren’t limited by the 50% cap. You receive what’s left, and reductions are often negotiable within these limits.

Understanding the Problem

You want to know, under North Carolina personal injury law, how much cash you can take home from a mid-range lump-sum settlement after paying a one-third attorney’s fee and resolving medical bills from an emergency room visit and a follow-up doctor. The decision point is: can you estimate and improve your net recovery without dragging the case out?

Apply the Law

North Carolina law puts attorney fees first, then limits what medical providers with valid liens can take from the remainder. Providers who perfect their liens share up to 50% of the post-fee funds, generally on a pro rata basis if the pot is too small to pay everyone in full. Government or plan reimbursement rights (such as Medicaid, Medicare, or the State Health Plan) may have special rules and, in some cases, are not subject to the 50% cap. Settlement funds must be held in the attorney trust account until liens are resolved and paid according to these rules.

Key Requirements

• Fees come off the top: Contingency fees (here, one-third) are subtracted from the gross settlement before medical liens are paid.
• Medical lien cap: Perfected hospital/doctor liens together cannot exceed 50% of the post-fee amount; if they exceed that, they are prorated.
• Perfection matters: Providers must properly assert and support their liens (e.g., itemized bills/records on request) or risk losing lien priority.
• Government/plan payors: Medicaid, Medicare, and the State Health Plan have statutory reimbursement rights; some are not limited by the 50% cap.
• Trust account disbursement: Your attorney must hold funds, verify lien amounts, negotiate reductions where possible, and disburse by statute.
• Your net: You receive what remains after fees and valid lien repayments; smart timing and negotiation can increase the net within these rules.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Creates liens for hospitals and medical providers and conditions enforceability on cooperation (e.g., furnishing records/bills).
• North Carolina Gen. Stat. § 44-50 (Payment and cap) - Attorney’s fee has priority; total medical liens are capped at 50% of the funds remaining after fees, with prorated sharing if needed.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) - Establishes Medicaid’s right to recover from third-party settlements, with statutory limits and allocation rules.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Grants the State Health Plan reimbursement/subrogation rights that are not restricted by the 50% medical lien cap.

Analysis

Apply the Rule to the Facts: With a one-third fee, that percentage is deducted first from the insurer’s mid-range offer. Your ER and follow-up physician bills can assert medical liens, but together they can take no more than 50% of what remains after the fee; if the capped amount won’t cover all charges, they share it pro rata. If Medicaid or Medicare paid some bills, those claims must be resolved under their specific rules before disbursement. Your net is the balance after these payments; timely negotiation can improve it without prolonging the case.

Process & Timing

1. Who files: Your attorney. Where: No court filing is required; liens are resolved directly with providers and agencies in North Carolina. What: Request and review itemized bills/records; obtain lien assertions; confirm Medicaid (NCDHHS Third Party Recovery) and/or Medicare (BCRC) conditional payment amounts; prepare a written settlement statement. When: Start before you accept the offer or sign a release to keep leverage for reductions.
2. Negotiate and confirm: Ask providers to reduce balances to fit the 50% cap and prorate fairly; verify final Medicaid/Medicare/plan demands. This step commonly takes a few weeks; government payors may take longer depending on responsiveness.
3. Disburse and close: Your attorney pays approved liens from the trust account, issues you the net check, and provides a closing statement showing fee, costs, lien payments, and your take-home amount.

Exceptions & Pitfalls

• Unperfected provider liens may not be enforceable; asking for itemized bills/records can surface perfection issues that support reductions.
• Medicare must be repaid under federal law; interest can accrue if payment is delayed after the final demand.
• The State Health Plan’s reimbursement rights are not limited by the 50% cap applied to medical providers.
• If multiple providers claim more than the capped amount, ensure prorated distribution rather than paying one provider in full.
• Sign the release only after you see a written net-to-client estimate and a plan for resolving every lien.

Talk to a Personal Injury Attorney

If you're weighing a settlement and want to maximize your net after fees and medical lien repayments, our firm can help you understand your options and timelines. Call us today.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.