Can a physical therapy provider require a letter confirming that an attorney represents the injured person?

Why a Physical Therapy Office May Ask for the Letter

A letter of representation is a short notice confirming that an attorney represents an injured person concerning a particular incident. It usually identifies the patient, the date of the incident, the attorney’s contact information, and the limited matter for which the attorney was retained.

A physical therapy office may request this letter when the patient wants treatment related to a personal injury claim but cannot pay the full balance at each visit. The office may want to know where to send records, bills, and notices concerning an asserted claim against future settlement proceeds.

The provider may generally decline to enter a deferred-payment arrangement unless its administrative requirements are met. That does not make an attorney letter a statewide prerequisite for receiving physical therapy. Another office may accept health insurance, self-payment, a payment plan, or a different billing arrangement without requiring proof of representation.

Is a Medical Referral Also Required in North Carolina?

Do not assume that an attorney letter and a medical referral serve the same purpose. They do not.

North Carolina’s Physical Therapy Practice Act defines physical therapy to include patient evaluation and treatment, as well as the interpretation and implementation of referrals. The law does not establish an across-the-board rule that every patient must first obtain a physician referral. You can review the statutory definition in N.C. Gen. Stat. § 90-270.90.

Even so, a referral or written order may still be requested because of:

• The physical therapy practice’s intake policy.
• The requirements of a health plan or other possible payment source.
• A need to document what treatment was recommended and why.
• The physical therapist’s conclusion that the condition should be evaluated by another licensed health care provider.

North Carolina law requires a physical therapist to refer a patient to a licensed medical doctor or dentist when the patient’s condition should have been determined to be outside the therapist’s scope of practice. Whether a particular payer will cover treatment without a referral depends on the governing plan terms and authorization rules. Direct access to a physical therapist does not necessarily mean that a health plan will pay without prior approval.

A Representation Letter Is Not Automatically a Medical Lien

Some providers use the phrase “attorney letter” when they are actually asking the patient or attorney to sign a lien, assignment, protection letter, or deferred-payment agreement. These documents may create different obligations. Read the document carefully and ask whether the patient will remain responsible for the balance if the injury claim produces no recovery or does not produce enough money to pay the bill.

North Carolina has statutes addressing certain medical claims against personal injury proceeds. Under N.C. Gen. Stat. § 44-49, a qualifying provider seeking to perfect a statutory lien must, upon request by the injured person’s attorney, furnish an itemized statement, hospital record, or medical report without charge and within the statutory period, and provide written notice of the claimed lien to the attorney.

N.C. Gen. Stat. § 44-50 addresses the handling of settlement or recovery funds after notice of qualifying medical claims. These rules do not mean that every physical therapy bill automatically creates a valid lien. The provider, services, notice, records, and other statutory requirements must be evaluated. A basic representation letter does not establish all of those requirements by itself.

Questions to Ask Before Scheduling Physical Therapy

When contacting nearby Durham physical therapy providers, ask the same questions of each office. This makes it easier to compare availability and avoid misunderstandings about payment.

1. Are you accepting new patients? Ask about location, appointment availability, and accessibility needs.
2. Do you require a referral or written order? If treatment was already recommended, ask whether the existing visit summary or order is sufficient.
3. Will you submit claims to the patient’s health plan? Confirm participation and authorization requirements directly with both the provider and the plan. Do not assume coverage.
4. Do you accept self-payment or payment plans? Request the written financial policy before treatment begins.
5. Why is an attorney letter required? Ask whether the office merely needs confirmation of representation or wants a lien, assignment, or payment agreement.
6. Who is responsible if the injury claim is denied? Obtain the answer in writing rather than relying on a telephone conversation.
7. How are records and bills released? Ask what authorization the patient must sign and whether the office will provide itemized statements and visit records.

If the injured parent is the patient, the parent will ordinarily need to sign the provider’s intake, financial, and records-authorization forms unless another person has legal authority to act for the parent. Merely helping arrange appointments does not automatically authorize disclosure of the parent’s medical information.

Documents to Gather and Preserve

• The recommendation, referral, or order for physical therapy.
• The provider’s intake and financial policies.
• The health plan card and any available coverage or authorization correspondence.
• Any representation letter sent by the attorney.
• Every proposed lien, assignment, or deferred-payment form.
• Appointment confirmations, visit summaries, itemized bills, and payment receipts.
• Letters, emails, and notes of conversations with providers or claim adjusters.

Medical records and itemized bills can help show what care occurred and whether it related to the claimed injury. Accurate documentation also matters because insurers may question unexplained delays or gaps in care. If scheduling, transportation, cost, or authorization problems cause a delay, preserve the communications showing what happened rather than trying to recreate the timeline later.

How This Applies to an Injured Parent

Because physical therapy has already been recommended, the practical first step is to ask the recommending provider to send the order or visit summary to the selected physical therapy office. Then ask the therapy office whether it needs a medical referral, payer authorization, proof of representation, or a separate financial agreement.

If an attorney already represents the parent, the parent can authorize the attorney to confirm that relationship. The attorney should review any request before sending a letter that contains payment promises or broader terms. If no attorney has been retained, tell the provider that plainly and ask whether it offers another billing method or whether another nearby Durham provider has different intake requirements.

Hiring an attorney and selecting medical care are separate decisions. A person should not assume that retaining counsel guarantees access to a particular provider or that the personal injury claim will pay every therapy charge.