Short Answer

In North Carolina, hospitals, EMS, and other health care providers may claim a statutory lien against your personal-injury recovery. You get exact amounts by demanding written lien statements and itemized bills from each provider and by checking any statutory payors (Medicaid, Medicare, or the State Health Plan). No courthouse filing is required to perfect these liens—providers perfect them by written notice to you/your attorney or the insurer. Attorney’s fees come off first, and all provider liens together cannot take more than 50% of the remainder.

Understanding the Problem

You want to know how, in a North Carolina personal injury case, you can confirm the exact dollar amounts owed to medical providers who say they have liens. The key decision is: how do you verify, in writing, every lien amount you must protect before you settle or disburse funds? One salient fact here is that your health insurer denied some treatment as late-submitted, so provider balances may be higher than expected.

Apply the Law

North Carolina law gives health care providers a lien on your personal-injury settlement for their reasonable charges related to your injury. Providers perfect their liens by giving written notice to you, your lawyer, or the liability insurer handling the claim; they do not file with the court. On request, providers must supply itemized statements and records so you can confirm the amount and reasonableness of the charges. Your attorney’s fees and costs are paid first; then all provider liens together are limited to no more than 50% of the settlement remainder. If multiple providers are owed and the cap is exceeded, they share pro rata. Statutory payors like Medicaid, Medicare, and the State Health Plan have separate repayment rights you must resolve before disbursement. Disputes over lien validity or distribution can be brought in Superior Court if needed.

Key Requirements

• Written notice of lien: A provider must give written notice to you/your attorney or the liability insurer; no court filing is required.
• Itemized support: Upon written request, the provider must supply an itemized bill and medical records so you can verify what is injury-related and reasonable.
• Attorney’s fees first: Your attorney’s fees and case costs are paid before any provider liens.
• 50% cap on providers: All providers combined cannot receive more than 50% of the net settlement after attorney’s fees and costs.
• Pro rata sharing: If total valid liens exceed the cap, providers share proportionally.
• Statutory payors: Medicaid, Medicare, and the State Health Plan assert separate repayment claims that must be confirmed and resolved in writing.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Health care provider lien) - Creates provider liens on personal injury recoveries and requires itemized statements/records upon request.
• North Carolina Gen. Stat. § 44-50 (Enforcement and distribution) - Attorney’s fees come first; provider liens share up to 50% of the remainder, pro rata if necessary.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien/third-party recovery) - Establishes Medicaid’s recovery rights against liability recoveries.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Authorizes the State Health Plan to recover paid benefits from third-party liability funds.

Analysis

Apply the Rule to the Facts: Because some treatment was denied by your health insurer as late, several providers (including EMS and hospitals) likely issued lien notices. Your attorney should request itemized statements and medical records from each provider to verify injury-related charges and reasonableness. After calculating attorney’s fees/costs, the lawyer will apply the 50% cap to the net and, if needed, allocate pro rata among providers. If Medicaid or Medicare paid any bills, their repayment must be confirmed and satisfied before any disbursement to providers or you.

Process & Timing

1. Who files: Your attorney. Where: No court filing is needed to perfect liens; requests go to each provider’s lien/billing office and any insurer handling the claim. What: Send written requests for (a) lien confirmation with current balance, (b) itemized statement, and (c) records for injury-related dates of service. Also request written lien/repayment statements from Medicaid, Medicare, and the State Health Plan if applicable. When: Begin as soon as settlement is likely and always before disbursing any funds.
2. Reconcile and negotiate: Match itemized charges to the injury, flag non-injury or duplicate entries, and request corrections or reductions. Confirm whether each provider properly perfected its lien by written notice.
3. Finalize distribution: Calculate attorney’s fees/costs, apply the 50% cap to the net, and allocate pro rata among valid provider liens. Obtain written releases or paid-in-full letters. If a provider disputes the amount or validity and won’t resolve informally, hold the disputed sum in trust and consider a Superior Court action (e.g., interpleader) for a distribution order.

Exceptions & Pitfalls

• Unperfected liens: If a provider never gave written lien notice, the statutory lien may not attach; verify perfection before paying.
• Insufficient documentation: Providers must furnish itemized statements and records on request; unresolved or unsupported charges can be disputed.
• Pro rata issues: When liens exceed the cap, pay providers proportionally; do not prefer one provider over another without agreement.
• Statutory payors first: Medicaid/Medicare/State Health Plan have separate rights; coordinate their repayments before paying providers or the client.
• Scope of charges: Confirm that billed services are injury-related and reasonable; remove unrelated dates of service or duplicate facility/professional charges.

Talk to a Personal Injury Attorney

If you're facing medical liens on a North Carolina injury claim and need to confirm exact amounts, our firm has experienced attorneys who can help you understand your options and timelines. Call us today to discuss your case.

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.