Short Answer

In North Carolina, your attorney must pay valid medical liens and certain legal reimbursements (like Medicaid, Medicare, or the State Health Plan) from your settlement before issuing your net check. Medical providers who properly perfect a lien are paid from the settlement under statutory rules, and the total paid to all such providers is capped at 50% of the amount recovered after attorney’s fees. Your lawyer should hold funds in a trust account, confirm and negotiate all claims, then disburse with a written settlement statement.

Understanding the Problem

You want to know how, at the end of a North Carolina personal injury case, to ensure that medical liens and other treatment-related debts are paid out of your settlement so your final check is clean. Here, you’ve already agreed to a settlement and are signing a release; your settlement statement lists attorney’s fees, medical liens, and your net amount, and you also paid some medical and therapy bills out of pocket that you want reimbursed.

Apply the Law

North Carolina law allows medical providers who treated you for accident injuries to secure a lien against your recovery if they follow the statutory steps. Those perfected liens must be paid from the settlement before you receive your net funds, and all such providers share a capped portion of the recovery after attorney’s fees. Separate rules require reimbursement to public programs (Medicaid), federal programs (Medicare), and the State Health Plan when they paid your accident-related bills. Your attorney typically administers these payments from the law firm trust account before disbursing your share.

Key Requirements

• Perfected medical lien: A provider who treated your accident injuries must give written notice of its claim and, upon request, furnish itemized bills/records to hold a lien on your settlement.
• Cap on provider liens: After paying attorney’s fees, the total paid to all perfected medical-provider lienholders cannot exceed 50% of the remaining recovery; providers share this amount, usually pro rata.
• Mandatory reimbursements: Medicaid, Medicare, and the North Carolina State Health Plan may require repayment from your settlement for amounts they paid; these are handled and paid from the trust account before client funds are released.
• Trust-account disbursement: Your lawyer holds the settlement, verifies every claim, negotiates reductions where possible, obtains written payoff letters, and pays lienholders and reimbursements before issuing your net check with a settlement statement.
• If a dispute remains: Your lawyer can hold the disputed amount in trust and ask a court to decide who is entitled to it; the undisputed funds can usually be disbursed.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical Liens – Perfection) - Providers obtain a lien by giving written notice and furnishing itemized charges/records upon request.
• North Carolina Gen. Stat. § 44-50 (Medical Liens – Payment and Cap) - Attorney must pay perfected liens from the settlement; the total to all providers is capped at 50% of the recovery after attorney’s fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien/reimbursement) - Medicaid has a statutory reimbursement claim against third-party recoveries; notice and allocation rules apply.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - The State Health Plan has subrogation/reimbursement rights when it pays for injury-related care.

Analysis

Apply the Rule to the Facts: Your signed release is standard and does not change lien-payment rules. Because your settlement statement itemizes medical liens, your lawyer should verify which providers perfected liens and apply the statutory 50% cap after fees to those items. Amounts you already paid out of pocket can be reimbursed after your lawyer pays perfected liens and any required Medicaid/Medicare/State Health Plan reimbursements from the trust account. Once all payoffs are confirmed, the firm can mail your net check to the address you provided.

Process & Timing

1. Who files: Your attorney. Where: The law firm’s North Carolina trust account. What: Collect lien notices and itemized bills; request Medicaid/Medicare/State Health Plan payoff amounts; confirm perfection and negotiate reductions. When: Before any client disbursement; public-program responses can take weeks, so start requests early.
2. Apply the statutory cap to perfected provider liens after deducting attorney’s fees, resolve any health-plan claims, get written payoff/release letters, and, if a dispute remains, hold that portion in trust and consider asking a court to decide.
3. Issue a final, signed settlement statement; pay lienholders and required reimbursements from trust; then mail your net recovery with copies of payoff confirmations for your records.

Exceptions & Pitfalls

• Wrongful death settlements follow different rules; medical expenses payable from those proceeds are limited by statute and often require court involvement.
• If a provider does not furnish itemized charges/records upon request, its statutory lien may be unenforceable; the bill can still be a debt, so confirm before ignoring it.
• Employer health plans may assert reimbursement rights under plan terms or federal law; rules and proof requirements differ from provider liens.
• Make sure every lien claimant has your attorney’s correct contact info; missed notices can delay disbursement or trigger disputes.

Talk to a Personal Injury Attorney

If you're dealing with medical liens, insurance reimbursements, or final settlement disbursement questions, 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.