How can I confirm whether a health plan has a valid reimbursement or subrogation lien against an injury settlement?
How can I confirm whether a health plan has a valid reimbursement or subrogation lien against an injury settlement? - North Carolina
Short Answer
In North Carolina, you confirm a health plan’s reimbursement/subrogation claim by getting it in writing from the plan (or its recovery vendor) and verifying the legal basis for the claim (plan language or a specific statute) and the amount tied to accident-related payments. If the plan will not respond, you typically document your notice attempts, request a written “lien/reimbursement statement” with an itemized payment history, and (when applicable) use North Carolina’s lien statutes to test whether the lien was properly created and noticed. The right approach depends on whether you are dealing with a private health plan, Medicaid, the State Health Plan, or a provider/hospital lien.
Understanding the Problem
If you settled a North Carolina injury claim and you (as the injured person’s attorney) have repeatedly sent referral materials to the health plan’s subrogation vendor but received no response, the practical question is: can you confirm whether the plan actually has a valid reimbursement/subrogation claim that must be resolved before you disburse settlement funds?
Apply the Law
North Carolina uses different rules depending on who is asserting the claim. Some claims are statutory “liens” (for example, certain provider liens and certain government plan claims). Others are contractual reimbursement/subrogation claims (common with private employer health plans), which usually require you to confirm the plan terms and the accident-related payments the plan made. The safest confirmation is a written statement from the plan/vendor that (1) identifies the legal basis for recovery, (2) lists the accident-related payments, and (3) states the current payoff amount and any dispute/appeal process.
Key Requirements
Identify the type of claimant: The confirmation steps change depending on whether the claim is from Medicaid, the State Health Plan, a private health plan, or a provider/hospital asserting a Chapter 44 lien.
Confirm the legal basis: A valid claim usually depends on either (a) a statute that creates a lien/subrogation right, or (b) plan language that creates a reimbursement/subrogation right.
Confirm the scope (accident-related payments only): You should request an itemized list of payments and verify they relate to the injury at issue, not unrelated care.
Confirm notice/perfection requirements (when it’s a Chapter 44 lien): For many provider/hospital liens, the lien is not valid unless the lienholder provides an itemized statement and written notice of the lien to the injured person’s attorney after a request, within the statutory time window.
Confirm the amount and any caps/proration rules: Some North Carolina lien statutes include caps and pro-rata distribution concepts that affect what is actually payable from settlement proceeds.
Document your notice and follow-up: If the plan/vendor is unresponsive, your paper trail (letters, fax confirmations, portal screenshots, certified mail receipts) becomes part of how you show you acted reasonably before disbursing.
N.C. Gen. Stat. § 108A-57 (Medicaid subrogation; notice and timing) - Gives Medicaid subrogation rights and includes a 30-day notice requirement after receipt of settlement/judgment proceeds, plus a 30-day window to ask a court to determine the Medicaid portion in certain disputes.
Apply the Rule to the Facts: Here, the key problem is not whether the client had treatment, but whether the health plan (through its vendor) has actually opened a recovery file and is asserting a claim tied to the settlement. Because you have already sent referral materials multiple times and the claim has settled, the next practical step is to force clarity in writing: either a confirmation that no claim is being asserted, or a written payoff package that states the basis and amount. If the “lien” being discussed is actually a Chapter 44 provider lien, North Carolina law makes validity depend on proper notice and an itemized statement after request.
Process & Timing
Who files: No court filing is required just to confirm a private health plan claim; you (the attorney) typically request confirmation in writing. Where: With the health plan’s recovery/subrogation address, portal, or vendor contact. What: A written request for (i) confirmation the case is opened, (ii) the legal basis for reimbursement/subrogation (plan language or statute), (iii) an itemized payment ledger, and (iv) a written payoff amount and dispute process. When: As soon as settlement is reached and before disbursement.
If the claim might be Medicaid or the State Health Plan: Confirm coverage type immediately and follow the program’s required notice steps. For Medicaid, North Carolina law imposes a 30-day notice obligation after receipt of proceeds and provides a 30-day window to seek a court determination in certain disputes.
If the claim is a Chapter 44 provider lien: Send a written request for the itemized statement/records and written notice of lien. If the lienholder does not provide what the statute requires after request, that can affect whether the lien is valid under North Carolina law.
Exceptions & Pitfalls
“Lien” vs. “reimbursement claim” confusion: Many private health plans do not have a North Carolina statutory lien like a hospital/provider lien; instead, they rely on plan contract language. You still need written confirmation of the basis and amount before treating it like a payable lien.
Wrong entity contacted: Plans often outsource recovery. If you only send materials to a vendor intake address and never confirm the plan’s official recovery address, you can lose time. Ask the plan directly (member services or benefits administration) where reimbursement/subrogation demands must be sent.
Overbroad payment ledgers: Demand itemization and verify the dates of service and diagnosis codes (or descriptions) match the accident. Accident-related payments are the usual focus; unrelated care should be disputed promptly and in writing.
Chapter 44 notice requirements: For provider/hospital liens under Chapter 44, validity can depend on proper written notice and an itemized statement after request. Do not assume a lien is enforceable just because a provider says it exists.
Government payers have their own rules: Medicaid and the State Health Plan have statutory rights and timelines. Treat these as priority tasks once you confirm they are involved.
Disbursing too early: If you disburse without resolving known, noticed lien claims, you can create avoidable disputes. If the plan/vendor is unresponsive, document your efforts and consider holding the disputed amount in trust until you get written confirmation or a clear resolution path.
Conclusion
To confirm whether a health plan has a valid reimbursement or subrogation claim against a North Carolina injury settlement, get a written statement identifying the legal basis (plan terms or a statute) and an itemized ledger of accident-related payments with a payoff amount. If the claim is a Chapter 44 provider lien, validity can depend on written notice and an itemized statement after request under North Carolina law. Next step: send a written demand for confirmation and itemization to the plan and its recovery vendor, and if Medicaid is involved, provide the required notice within 30 days of receiving the proceeds.
Talk to a Personal Injury Attorney
If you’re dealing with a settlement and can’t get a clear answer from a health plan or its recovery vendor about reimbursement or subrogation, our firm has experienced attorneys who can help you identify the right payer category, request the right documentation, and protect your timeline for disbursement and closing the file. Reach out today.
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.
