Does my attorney need to send a letter of representation before a physical therapist can treat me under my injury claim?

Why Would a Physical Therapy Provider Request the Letter?

A letter of representation generally confirms that an attorney represents you concerning a particular accident or injury claim. It may identify the date of the incident, provide the attorney’s contact information, and ask the provider to send records, bills, or lien notices to the law office.

The letter is usually an administrative document rather than permission to provide care. It is not the same as a medical referral, treatment order, insurance authorization, or promise that a settlement will occur.

A physical therapy office may request the letter when it is considering treatment without immediate payment. The office may want confirmation that there is an active claim and a place to send billing information. It may also want to know whether an attorney will address a properly documented medical claim from any future recovery.

Because each provider sets its own payment policies, ask what the office actually requires. A request for a basic representation letter can be different from a request for a lien acknowledgment, assignment, payment guarantee, or agreement sometimes called a letter of protection. Your attorney may need to review the proposed terms before signing anything.

A Representation Letter Does Not Guarantee Payment

The letter does not make the attorney personally responsible for the therapy charges. It also does not require the liability insurer to authorize treatment or pay bills as they are incurred. If liability remains unresolved, the insurer may continue investigating before deciding whether it accepts responsibility for the claim.

The patient may remain responsible for the bill under the provider’s financial agreement, even if the provider agrees to wait for the claim to be resolved. Before treatment resumes, it is reasonable to ask the therapy office:

• Whether it plans to bill health insurance, bill you directly, or wait for the injury claim.
• Whether you will owe the charges if there is no recovery.
• What document it wants from the attorney and what that document is intended to accomplish.
• Whether the office is claiming a lien or requesting a separate payment agreement.
• How records and itemized bills will be provided to you or your attorney.

How North Carolina Medical Liens May Affect the Request

North Carolina has statutes addressing certain medical claims against personal injury recoveries. Under N.C. Gen. Stat. § 44-49, a qualifying medical provider may assert a lien against money recovered for injury-related services. Whether a particular physical therapy bill qualifies depends on the provider, the services, the required notices, and compliance with the statute.

A representation letter by itself does not perfect a statutory lien. Among other requirements, the provider generally must give the attorney written notice that it is claiming a lien. When requested by the attorney, the provider must also supply an itemized statement, medical report, or qualifying record without charge and within the period stated by the law.

If a qualifying lien has been properly asserted and recovery funds are received, N.C. Gen. Stat. § 44-50 may require funds to be retained for just and bona fide medical claims before the remaining proceeds are distributed. These lien rules concern possible payment from a recovery; they do not require a provider to begin or continue treatment.

How This Applies When Treatment Has Already Ended

If the provider closed an earlier therapy episode and now wants documentation from counsel before continuing under the personal injury claim, the immediate issue is likely the provider’s billing or account policy. Your attorney can contact the office to identify the exact document requested, but the attorney may need to clarify or decline terms that would create obligations beyond confirming representation.

The insurer’s assignment of a new adjuster does not prevent the attorney from sending a representation letter to the provider. At the same time, the letter will not resolve liability. A witness who has not responded may still matter to the underlying investigation, particularly if the parties disagree about how the incident occurred.

North Carolina allows contributory negligence to be raised as a defense. If the defense proves that an injured person’s own negligence helped cause the injury, it can create serious problems for the claim. Under N.C. Gen. Stat. § 1-139, the party raising contributory negligence generally bears the burden of proving it. Evidence should therefore address what the other party did and why the injured person’s conduct was reasonable.

If travel may interrupt treatment, notify the provider about the dates and ask how the office wants to handle scheduling. Keep a written record of the travel period, appointment availability, cancellation notices, and communications with the therapy office. Follow the instructions of your medical providers. Accurate documentation can help explain an interruption without assuming what effect, if any, it will have on the claim.

Information to Gather Before the Attorney Contacts the Provider

Providing organized information can make it easier to determine what the therapy office needs. Consider preserving:

• The provider’s written request for attorney documentation.
• The earlier physical therapy discharge or closing paperwork.
• Itemized bills, visit summaries, and account statements.
• Any financial agreement, lien form, or deferred-payment form presented by the office.
• Health insurance information and explanations of benefits, if applicable.
• The liability insurer’s claim number and new adjuster’s contact information.
• Emails, portal messages, and notes from telephone conversations with the provider.
• Your anticipated travel dates and any resulting appointment changes.

Do not assume that ongoing negotiations, treatment, an adjuster change, or a representation letter extends the deadline for filing a lawsuit. Claim discussions with an insurer generally do not pause or automatically extend an applicable North Carolina filing deadline.

Practical Next Steps

1. Ask the therapy office for its request in writing and the name of the exact document it requires.
2. Send that request and any proposed agreement to your attorney for review.
3. Confirm who will be billed and whether you remain responsible if the injury claim does not produce a recovery.
4. Keep copies of treatment records, bills, scheduling messages, and travel-related communications.
5. Continue preserving liability evidence, including the witness’s contact information and prior attempts to reach that person.

The key distinction is that a representation letter confirms the attorney’s role. It does not decide fault, direct medical care, or guarantee that a provider will be paid from the claim.