Short Answer

In North Carolina, do not approve or pay a medical lien you cannot verify. First, demand an itemized bill and related records from the provider and compare them to your insurance explanations of benefits. Then apply North Carolina’s lien limits and pro rata rules before any disbursement. If a lienholder (including EMS) will not cooperate or the math doesn’t add up, your attorney can negotiate, withhold payment pending proof, or ask the court to decide.

Understanding the Problem

You’re finalizing a North Carolina personal injury settlement and the statement shows several medical liens, but some numbers don’t match your insurance payments, and an EMS balance appears because it was never submitted to insurance. You want to know what you can and must do before funds are disbursed.

Apply the Law

North Carolina law gives medical providers a lien on injury settlements, but it also requires verification and caps how much providers can take from your recovery. Providers must supply itemized statements and related records on request. After attorney’s fees and costs of collection, valid provider liens are paid pro rata and are capped so that no more than half of the remaining settlement is used to pay them. Disputes over liens can be brought in Superior Court, and government or plan liens (Medicare/Medicaid/State Health Plan) have special rules.

Key Requirements

• Verification: Demand an itemized bill and injury-related records from each provider; compare to insurance EOBs and payments.
• Reasonableness: Only reasonable, injury-related charges are lienable; duplicates and non-injury items are not.
• Cap and pro rata split: After attorney’s fees/costs, all valid provider liens share no more than 50% of the remainder, pro rata.
• Government/plan liens: Medicaid and Medicare must be resolved per their statutes; some health plans have separate rights.
• Forum: If a lien remains disputed, a judge in Superior Court can determine validity and distribution.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Creates provider liens and requires itemized statements/records on request.
• North Carolina Gen. Stat. § 44-50 (Distribution and cap) - Pays attorney’s fees/costs first; then caps combined provider liens at 50% of the remainder, paid pro rata.
• North Carolina Gen. Stat. § 108A-57 (Medicaid third-party recovery) - Establishes Medicaid’s recovery and allocation rules from settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Grants the State Health Plan reimbursement rights separate from provider lien caps.

Analysis

Apply the Rule to the Facts: Because EMS did not submit to insurance, first require an itemized EMS bill and records, and compare against your policy and other EOBs to confirm the charges are injury-related and not duplicative. Next, calculate the net settlement after attorney’s fees/costs and apply the 50% cap for all provider liens combined, distributing pro rata. Finally, identify any Medicaid/Medicare/plan claims and resolve them under their specific rules before disbursing remaining funds.

Process & Timing

1. Who files: Injured person (through counsel). Where: Typically resolved by counsel; if needed, file in Superior Court in the North Carolina county where the case is pending or could be filed. What: Request itemized statements and records; if unresolved, seek a court order determining lien validity and distribution. When: Before any settlement disbursement.
2. Counsel verifies charges against EOBs, negotiates reductions, and applies the 50% post-fee cap with a pro rata split among verified providers; expect several weeks if multiple providers or government payers are involved.
3. Obtain written lien releases or payoff letters and issue final disbursements consistent with the court order or agreed allocations.

Exceptions & Pitfalls

• Government and plan claims: Medicare must be reimbursed; Medicaid recovery follows statute; some health plans may assert reimbursement rights outside the provider lien cap.
• Missing documentation: If a provider won’t supply itemized bills/records upon request, do not pay until verified; challenge non-injury or duplicate items.
• Over-cap payments: Do not pay more than 50% of the post-fee remainder to providers in total; use a pro rata split.
• Balance billing issues: Where insurance paid and contractual write-offs apply, confirm you’re not being charged amounts the provider agreed to waive.
• Service/notice traps: Keep written requests, EOBs, and correspondence; if you seek court help, serve all lien claimants to bind them to the order.

Talk to a Personal Injury Attorney

If you're dealing with disputed or unverified medical liens on a North Carolina injury 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.