Short Answer

In North Carolina, medical liens do not come from the insurer. They arise by statute in favor of your client’s health care providers and attach to any personal injury settlement or judgment. To protect and verify liens, you gather itemized bills and lien notices from providers and give notice to the liability insurer. Attorney’s fees come off the top, and medical liens are capped by statute at a portion of the net recovery; unresolved disputes can be decided by the Clerk of Superior Court.

Understanding the Problem

You are asking whether you can obtain a “medical lien” from the insurer in a North Carolina personal injury matter. Here, counsel represents the injured client, left a voicemail with the insurer’s risk services, asked for a lien, and still has no claim or policy information. The narrow issue is: in North Carolina, how do you properly secure, verify, and have the insurer honor medical provider liens tied to a personal injury claim?

Apply the Law

North Carolina law gives treating medical providers a statutory lien on a personal injury recovery. The lien attaches to settlement or judgment proceeds when the provider has furnished care related to the injury and proper notice and itemization are provided. The liability insurer must protect valid liens it knows about when paying claims. Attorney’s fees are paid first; then provider liens are limited to a statutory share of the remaining funds. If there is not enough to pay all liens within the cap, they are shared proportionally; disputes can be brought to the Clerk of Superior Court. Separate repayment rules apply to Medicare, Medicaid, and the State Health Plan.

Key Requirements

• Provider-based lien: The lien belongs to each medical provider that treated the injury; it is not issued by the insurer.
• Notice and itemization: Providers must provide, upon request, an itemized statement of charges and relevant records for the lien to be enforceable.
• Attachment to recovery: The lien attaches to settlement/judgment proceeds from the liable party or insurer that has notice.
• Attorney’s fees priority: Reasonable attorney’s fees are paid first from the gross recovery.
• 50% cap on medical liens: The combined statutory medical liens cannot exceed one-half of the recovery after attorney’s fees; if insufficient, lienholders share pro rata.
• Forum for disputes: If providers, insurer, and counsel cannot agree on allocation, a petition may be filed with the Clerk of Superior Court to determine distribution.
• Public program claims: Medicare must be reimbursed under federal law; Medicaid and the State Health Plan have separate statutory rights that may differ from the standard cap.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Health care provider liens) - Establishes provider liens and record/billing requirements.
• North Carolina Gen. Stat. § 44-50 (Payment and distribution; 50% cap) - Sets attorney fee priority and caps total medical liens from the net recovery.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien/recovery) - Authorizes Medicaid recovery from third-party liability settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Provides State Health Plan recovery rights separate from the standard cap.

Analysis

Apply the Rule to the Facts: Because liens come from providers, not the insurer, the next step is to collect itemized bills and lien notices from every treating provider and put the insurer on written notice. Attorney’s fees will be paid first; then you will allocate up to half of the remaining recovery to valid provider liens. If the insurer remains unresponsive or if lienholders cannot agree on pro rata allocation within the cap, seek relief with the Clerk of Superior Court.

Process & Timing

1. Who files: Plaintiff’s counsel. Where: Work the claim with the liability insurer; bring any allocation dispute to the Clerk of Superior Court in the North Carolina county where the action is filed or where funds are held. What: Send a representation letter, HIPAA authorization, and requests for the claim number and coverage. Obtain each provider’s itemized statement and written lien notice; send insurer a lien-protection letter enclosing them. When: Do this early—well before settlement—so the insurer can properly include liens on payment.
2. Follow up: If the insurer is silent, follow up in writing (email and certified mail) and escalate to a supervisor. Remind the insurer it must protect valid liens it knows about at disbursement. Continue updating the lien stack as additional bills arrive.
3. Resolve and distribute: At settlement, deduct attorney’s fees first. Apply no more than one-half of the remaining proceeds to statutory medical liens, shared pro rata if needed. If any provider (or the insurer) disputes the distribution, file a short petition with the Clerk of Superior Court asking for allocation and an order authorizing disbursement.

Exceptions & Pitfalls

• You do not “get” a lien from the insurer; providers hold the liens, and the insurer protects them at payment if it has notice.
• A provider’s lien depends on providing itemized charges and relevant records upon request; keep written requests and responses.
• Medicare must be reimbursed under federal law; do not rely on the state 50% cap for Medicare claims. Medicaid and the State Health Plan have separate statutory recovery rules.
• If liens exceed the cap, pay them pro rata within the cap; do not favor one provider over another without agreement or a court order.
• When in doubt or if negotiations stall, petition the Clerk of Superior Court for allocation before distributing funds.

Talk to a Personal Injury Attorney

If you're dealing with an insurer that won't confirm claim details or acknowledge provider liens, 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.