Short Answer

In North Carolina, a subrogation service generally needs your letter of representation, HIPAA-compliant authorizations, itemized medical bills and balances, proof of any insurer payments (like MedPay), settlement documentation, and insurer/adjuster details. State law requires providers to furnish itemized statements and records with proper authorization, and any lien must be paid from settlement funds subject to attorney fee priority and statutory caps.

Understanding the Problem

In North Carolina personal injury cases, what do we (the law firm) need to send a subrogation service so it can recover medical liens from a settled motor vehicle accident? One key fact: the at-fault driver had no liability insurance, and MedPay benefits were used.

Apply the Law

North Carolina law gives medical providers and certain payers rights in personal injury recoveries. A provider’s lien attaches to settlement proceeds when the provider, upon proper authorization, furnishes itemized charges and related records. Attorneys’ fees are paid first, and providers then share in the remaining funds up to statutory limits. Government programs (like Medicaid) and the State Health Plan have separate recovery rules that must be addressed before disbursing client funds.

Key Requirements

• Provider lien basics: The provider must be able to furnish an itemized statement and pertinent records with a valid patient authorization before asserting payment from settlement funds.
• Attorney fee priority: Attorneys’ fees and costs come off the top; provider liens are paid from the client’s net recovery after those fees.
• 50% cap coordination: Medical provider liens share up to a statutory portion of the client’s net (after fees), requiring pro rata reductions if total liens exceed available funds.
• Government payors: Medicaid and the State Health Plan have distinct statutory recovery rights; their procedures and caps differ from provider liens and must be resolved.
• Hold funds until final figures: The attorney should obtain final lien amounts/releases and disburse consistent with the statutes before paying the client.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien requirements) - Allows recovery from settlement when providers furnish itemized statements/records with authorization.
• North Carolina Gen. Stat. § 44-50 (Distribution; attorney fees; caps) - Attorney fees have priority; providers share limited portions of the client’s net recovery.
• North Carolina Gen. Stat. § 108A-57 (Medicaid third-party recovery) - Governs Medicaid’s lien and allocation rules on third-party recoveries.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Sets the State Health Plan’s reimbursement/subrogation rights.

Analysis

Apply the Rule to the Facts: Because the claims are settled and MedPay was used, your subrogation package should include HIPAA authorizations so providers can release itemized bills and balances, MedPay payment records, and the settlement breakdown to apply the attorney-fee priority and statutory caps. With the at-fault driver uninsured, confirm any UM coverage and provide the adjuster’s information and policy documents so the subrogation service can verify sources of recovery and coordinate all liens before disbursement.

Process & Timing

1. Who files: The law firm (or subrogation service). Where: Send to each lienholder (providers, Medicaid/Medicare/State Health Plan if applicable) and to the paying insurer/adjuster in North Carolina. What: Letter of representation; HIPAA-compliant authorizations for each client; itemized provider bills and balances (or requests for them); proof of insurer payments (e.g., MedPay EOB/ledger); coverage documents (UM/UIM/MedPay declarations, policy numbers); adjuster name, email, and phone; settlement agreement/release (or settlement statement with gross/net, attorney fees/costs). When: Immediately after settlement and before disbursing funds.
2. Obtain final lien amounts and required releases/satisfaction letters; for multiple providers, coordinate pro rata reductions to comply with the statutory cap. For Medicaid or the State Health Plan, follow their written payoff procedures; agency timelines can vary.
3. Issue payments to lienholders per final statements, document all disbursements in the closing file, and disburse the net to the client with a final accounting.

Exceptions & Pitfalls

• Missing HIPAA authorizations delays providers’ itemized statements; liens cannot be verified without them.
• Paying one provider in full instead of coordinating pro rata reductions can violate the statutory cap and create exposure.
• Overlooking Medicaid or the State Health Plan recovery rights risks duplicate or improper payment; their rules differ from provider liens.
• Failing to obtain a final lien letter/release can trigger later demands; keep confirmations in the file.
• Service/notice gaps: send your representation and information requests early so providers can furnish itemized balances before closing.

Talk to a Personal Injury Attorney

If you're dealing with medical lien recovery after 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.