Short Answer

Yes—often. In North Carolina, an EMS provider can claim a medical lien against your injury settlement, but if the EMS bill is submitted to and paid by your health insurer, the lien should drop to what you still owe after insurance adjustments. Also, under state law, all medical provider liens together cannot take more than 50% of your recovery after attorney’s fees. Timing and your plan’s reimbursement rights can affect the net savings.

Understanding the Problem

You’re deciding whether to ask EMS to bill your health insurance now or to pay the EMS lien from your settlement so your lawyer can disburse funds. In North Carolina personal injury cases, EMS has asserted a third-party lien, but the bill has not gone through your health plan yet. You want to know which choice lowers what you pay out of pocket.

Apply the Law

North Carolina law gives medical providers, including EMS, a lien on any money you recover from a liable third party for your injuries. That lien is limited and must meet certain conditions. Your attorney’s fee comes off the top of the settlement, and medical liens are capped at a portion of what remains. Providers must also cooperate with billing and records requests tied to the lien. There is no court filing needed to create the lien; your attorney resolves it before disbursing funds.

Key Requirements

• Covered medical services after an injury: The EMS charges must relate to treating the injury that led to your settlement.
• Provider cooperation: To enforce a lien, the provider must furnish itemized bills and records on request in the format the law allows.
• Recovery exists: The lien attaches only to money you recover from the at-fault party (or their insurer).
• Attorney’s fee priority: Your lawyer’s fee comes out first; liens are paid from the net that remains.
• 50% cap and possible pro rata sharing: All provider liens together cannot exceed 50% of your net recovery after attorney’s fees; if funds are short, providers may be paid proportionally.
• Effect of health insurance: If EMS bills your health insurer and accepts payment, the lien typically falls to your plan-allowed balance (copay/deductible) rather than the full, undiscounted charge.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Creates a lien for reasonable medical charges tied to an injury recovery and conditions enforcement on providing bills/records on request.
• North Carolina Gen. Stat. § 44-50 (Attorney fees and lien cap) - Gives attorney’s fees priority and limits total medical liens to no more than 50% of the recovery after attorney’s fees.

Analysis

Apply the Rule to the Facts: Because the EMS charges relate to your crash, they qualify for a lien against your third-party settlement. Your lawyer’s fee will be paid first. If EMS submits the bill to your health insurer and accepts the allowed amount, the remaining lien should reflect only your plan responsibility (for example, deductible or copay), which usually lowers what is paid from your settlement. Even if insurance will not pay now, the EMS lien cannot exceed 50% of your post-fee recovery, and your attorney can require itemized bills and records before paying.

Process & Timing

1. Who files: No court filing is required. Where: You or your attorney contact the EMS billing department and your health insurer. What: Provide insurance details and ask EMS to submit a claim; ask for an itemized bill and updated lien amount. When: Do this before your attorney disburses settlement funds so the lien reflects any insurance payments.
2. EMS submits the claim to your health insurer. Claims decisions often take 30–60 days, but timing varies and depends on the insurer’s timely filing limits (commonly 180–365 days from service).
3. Your attorney receives the Explanation of Benefits (EOB), verifies the remaining patient responsibility, pays EMS from settlement funds consistent with the 50% cap, and obtains a lien release.

Exceptions & Pitfalls

• If the timely filing window has passed, EMS may not be able to bill insurance; you can still negotiate within the 50% cap.
• Your health plan may claim reimbursement from your settlement for amounts it pays; factor this into expected savings.
• If multiple providers have liens, payments may be pro rata within the 50% cap; clearing the EMS lien alone may not control the total payout.
• Ensure EMS provides itemized bills and records on request; lack of cooperation can affect lien enforcement.
• Out-of-network issues can reduce the insurer’s payment; confirm network status and plan terms before delaying disbursement.

Talk to a Personal Injury Attorney

If you're dealing with an EMS lien and a pending settlement, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at [919-341-7055].

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.