Short Answer

In North Carolina, you receive your settlement check after your attorney deposits the insurer’s check into a trust account, the funds clear, and all valid medical and insurance liens are resolved and paid. Attorney’s fees come off the top, then medical liens are paid (capped at up to half of the remaining recovery), and the balance goes to you. Timing depends on how quickly lienholders issue final payoff letters and respond to reduction requests.

Understanding the Problem

You want to know when money from your North Carolina personal injury settlement will be in your hands and what has to happen first. Here, the key players are you (the injured person) and your attorney, and the critical step is paying valid medical and insurance liens tied to your settlement. One fact that often matters: you prepaid an ambulance bill and want to be reimbursed.

Apply the Law

Under North Carolina law, medical providers can assert liens against your personal injury settlement for reasonable charges related to your care. Your attorney must first deduct agreed fees and case expenses, then address valid liens. All medical provider liens together cannot take more than half of what remains after attorney’s fees. If lien claims exceed that cap, they share the limited amount proportionally. The distribution typically occurs from your attorney’s trust account, not a court. Some health plans and government payors have special statutory reimbursement rights that must be honored before funds are disbursed.

Key Requirements

• Identify and verify liens: Confirm which providers or plans have enforceable lien or reimbursement rights under North Carolina law.
• Attorney’s fees first: Fees and approved case costs are paid before medical liens.
• 50% cap on medical liens: After fees, no more than half of the remaining recovery can go to all medical provider liens combined, with pro rata sharing if the cap is reached.
• Perfection matters: A provider generally must furnish an itemized statement (and, upon request, records) to preserve a lien; failures can limit enforcement.
• Non-lien bills: Charges without a valid lien are typically paid, negotiated, or scheduled by you from your net share.
• Plan-specific rights: Some health plans (for example, certain government or self-funded ERISA plans) may have reimbursement rights separate from provider liens.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Allows providers to claim a lien on personal injury recoveries for reasonable charges when they furnish requested statements/records.
• North Carolina Gen. Stat. § 44-50 (Distribution and priority) - Attorney’s fees have priority; total medical liens are capped at up to one-half of the recovery after fees, with proportional reductions if needed.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien/reimbursement) - Establishes Medicaid’s reimbursement rights and procedures in injury settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan reimbursement) - Provides subrogation/reimbursement rights for the State Health Plan.

Analysis

Apply the Rule to the Facts: Your hospital system lien is a provider lien that, once itemized and verified, gets paid from the settlement after attorney’s fees and within the 50% cap. The “health insurer” claim depends on the plan: if it is a statutory or self-funded ERISA plan with enforceable rights, it must be resolved before distribution; if it lacks enforceable rights under North Carolina law, it can often be negotiated or denied. Your unpaid physical therapy bill, if not perfected as a lien, is typically handled from your net share. Your prepaid ambulance charge is not a lien; reimbursement to you usually comes from your net after valid liens are satisfied.

Process & Timing

1. Who files: Your attorney. Where: Attorney trust account in North Carolina. What: Signed release to the insurer; deposit of settlement check; collection of itemized lien statements and plan payoff letters; a written settlement statement. When: Funds are disbursed after the check clears and final lien amounts are confirmed; clearing often takes about a week, while lien confirmations can take several weeks depending on the provider/plan.
2. Your attorney requests itemized bills/records, verifies lien validity, and seeks reductions where appropriate. Government payors and certain plans may have their own response timelines; providers sometimes take 2–6 weeks to issue final figures.
3. Once amounts are final, your attorney pays attorney’s fees and costs, then pays valid liens (subject to the 50% cap and pro rata rules), and issues your check with a settlement statement explaining each payment.

Exceptions & Pitfalls

• Some health plans (for example, the State Health Plan or certain self-funded ERISA plans) have reimbursement rights that are separate from provider liens and must be honored before disbursement.
• Provider liens generally require an itemized statement (and, on request, records) to be furnished; if not provided, enforcement can be limited.
• If total lien claims exceed the statutory cap, they must be reduced proportionally; do not pay one lien in full and leave others unpaid.
• Medicare and Medicaid have special repayment rules; unresolved claims can delay payment and may carry penalties if ignored.
• Prepaid out-of-pocket bills (like your ambulance payment) are not liens; reimbursement to you comes from your net, after valid liens and fees.

Talk to a Personal Injury Attorney

If you’re navigating settlement disbursement and medical liens, our firm has attorneys who can help you understand your obligations and maximize your net recovery within North Carolina’s rules. Reach out 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.