Short Answer

In North Carolina, EMS and other medical providers can claim a lien against your personal injury settlement, but all provider liens together are limited to a portion of the recovery by statute after attorney’s fees. You can ask EMS to submit the bill to your health insurer now; if that is no longer possible, you can negotiate a reduction and enforce the 50% cap and pro‑rata share rules. You may also request an itemized bill and records; if a provider does not cooperate, that can affect its lien rights. Public programs (Medicare/Medicaid/State Health Plan) follow separate repayment rules.

Understanding the Problem

You’re finalizing a North Carolina personal injury settlement and see that EMS never billed your health insurance, leaving an unexpected balance on the settlement statement. The narrow question is: can you make EMS bill insurance now or otherwise limit what comes out of your settlement?

Apply the Law

Under North Carolina law, medical providers that treated injuries from an accident may assert a lien on your personal injury settlement. Providers must furnish an itemized statement and pertinent records upon request, and settlement funds are distributed by a specific order: attorney’s fees first, then medical liens capped so that providers share a defined portion of the remaining recovery. If multiple providers claim liens, they share the capped funds pro rata. Disputes are typically resolved during settlement; if needed, a judge in Superior Court can decide lien issues.

Key Requirements

• Covered services: The EMS bill must relate to treatment for the injury that produced the settlement.
• Records and itemization: On request, the provider should supply an itemized bill and necessary medical records at a reasonable charge.
• Distribution cap: After attorney’s fees, the total paid to all medical providers from the settlement cannot exceed a statutory percentage; providers share that amount.
• Pro rata sharing: If the capped amount is not enough to pay all liens in full, each provider receives a proportional share.
• Special payers: Medicare, Medicaid, and the State Health Plan follow separate statutory/federal repayment rules that may differ from the cap.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Creates medical provider liens on personal injury recoveries and requires providers to make itemized statements and records reasonably available.
• North Carolina Gen. Stat. § 44-50 (Distribution/cap) - Sets how settlements are distributed, including a cap on the total payable to medical liens after attorney’s fees and pro rata sharing among lienholders.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) - Establishes Medicaid recovery rights; procedures and limits differ from standard medical liens.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Authorizes the State Health Plan’s reimbursement rights, which are not governed by the standard medical lien cap.

Analysis

Apply the Rule to the Facts: Because EMS treated you for crash‑related injuries, it can claim a lien on your settlement. First, request an itemized EMS bill and relevant records; providers should cooperate, and failure to do so can affect lien enforcement. Ask EMS to submit the claim to your health insurer now; if the plan still accepts the claim, that usually lowers the amount EMS can claim from the settlement. If timely filing has passed or EMS will not bill, your attorney can enforce the statutory cap and require EMS to accept a pro rata share alongside other providers.

Process & Timing

1. Who files: Your injury attorney. Where: Directly with the EMS billing office and your health plan; courts only if a dispute cannot be resolved. What: Written request for an itemized bill and records, HIPAA authorization, and a request that EMS submit to your health insurer; if needed, a negotiation letter invoking lien-cap and pro rata rules. When: As soon as you spot the problem in your settlement review; ask EMS to submit within the health plan’s timely filing window (varies by plan).
2. If insurance submission is denied or time‑barred, negotiate a lien reduction by applying the statutory cap and pro rata distribution across all providers; expect a few weeks of back‑and‑forth, depending on the provider and county practices.
3. Finalize disbursements: your attorney’s fee comes off the top, then pay medical liens within the cap and pro rata rules; if EMS disputes, your attorney can hold the contested amount in trust and seek a Superior Court order to resolve the lien.

Exceptions & Pitfalls

• Medicare, Medicaid, and the State Health Plan: These programs have separate repayment rules and may not be governed by the standard medical lien cap; handle them first and carefully.
• Silence or delay: If EMS does not provide an itemized statement or needed records after a proper request, raise that in negotiations; it can affect the provider’s lien rights.
• Out‑of‑network issues: Even if EMS is out‑of‑network, your plan may process a claim you or EMS submit; ask your insurer about member‑submitted claims.
• Pro rata math: When multiple providers claim liens, each shares the capped pot proportionally; don’t let one lienholder exhaust the cap.

In North Carolina, EMS may assert a medical lien against your injury settlement, but providers are limited by statute to a capped portion of the recovery after attorney’s fees and must share that amount pro rata. Start by demanding an itemized bill and records and ask EMS to bill your health insurer; if that fails, apply the cap and negotiate a reduction. The practical next step is to have your attorney send a written request to EMS and your insurer immediately and then adjust lien payments within the statutory limits.

Talk to a Personal Injury Attorney

If you're dealing with an EMS bill that wasn't submitted to insurance and a tight settlement budget, 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.