Should I get copies of all medical bills and lien ledgers before signing my settlement statement?: Answered for North Carolina personal injury settlements
Should I get copies of all medical bills and lien ledgers before signing my settlement statement? - North Carolina
Short Answer
Yes. In North Carolina, medical providers have statutory lien rights on your personal injury recovery, and those liens must be calculated correctly before funds are disbursed. Getting itemized bills and lien ledgers lets you confirm reductions, apply the 50% cap on medical provider liens after attorney’s fees, and avoid paying deductibles or copays twice.
Understanding the Problem
You’re finalizing a North Carolina personal injury settlement and plan to sign a settlement statement. You have liens from your health insurer, two hospitals, and EMS, and you want to ensure your out-of-pocket deductible isn’t paid twice. The question is whether you should obtain and review each provider’s itemized bills and lien ledgers before you sign and allow disbursement.
Apply the Law
North Carolina law gives certain medical providers a lien on your personal injury recovery, but it also limits and conditions those liens. Providers must give itemized statements on request to enforce a lien; attorney’s fees come off the top; and the combined provider liens cannot exceed 50% of the net recovery after attorney’s fees. Separate rules may apply to government or plan payors like Medicaid, Medicare, or the State Health Plan. Disputes typically resolve through your attorney’s trust account before disbursement; unresolved issues can be addressed in Superior Court.
Key Requirements
Itemized statement on request: A provider seeking to enforce a medical lien must furnish an itemized bill upon request; without it, the lien cannot be enforced.
Attorney’s fee comes first: Your lawyer’s fee is paid before provider liens are calculated and paid from the recovery.
50% cap on medical provider liens: All medical provider liens together cannot exceed 50% of the net recovery after attorney’s fees.
Government/program payors may differ: Medicaid has a statutory lien; Medicare and the State Health Plan have separate reimbursement rights that must be resolved and may not be limited by the 50% cap.
Accuracy and no double payment: You are entitled to verify that insurer payments, contractual write-offs, and your deductible/copays are correctly reflected so you don’t pay twice.
Apply the Rule to the Facts: Because multiple hospitals and EMS are asserting liens, each must provide an itemized bill or ledger if requested before enforcing a lien, so you should request and review them. Your attorney’s fee is deducted first. The total paid to medical providers from your recovery cannot exceed 50% of the net after fees. Comparing provider ledgers to your health insurer’s payments ensures that contractual write-offs are applied and your deductible/copays are not paid twice.
Process & Timing
Who files: You or, more commonly, your attorney. Where: Directly with each lienholder/provider and any program payor (e.g., NC DHHS for Medicaid). What: Request an “itemized statement” and “lien ledger/account history” for accident-related care; request a final lien/demand letter from Medicaid/Medicare/State Health Plan if applicable. When: Before you sign the settlement statement and before any disbursement from the attorney trust account.
Reconcile numbers: Confirm insurer payments, write-offs, and your cost-share. Apply the attorney’s fee first, then ensure the combined provider liens do not exceed 50% of the net post-fee amount. Seek negotiated reductions where appropriate; expect several days to a few weeks depending on the provider.
Finalize disbursement: After reconciliations and reductions are documented, your attorney issues the settlement statement and pays lienholders per the statutes and any final government/program demands, then releases your check.
Exceptions & Pitfalls
Government/program rights: Medicaid, Medicare, and the State Health Plan may have separate statutory or federal rights that aren’t limited by the 50% medical provider cap—resolve these specifically.
Missing itemization: If a provider won’t furnish an itemized bill upon request, its lien is not enforceable until it does; make the request in writing and keep proof.
Double-payment traps: Compare health insurer explanations of benefits to provider ledgers to avoid repaying amounts already satisfied by insurance or paying your deductible/copay twice.
Priority/order errors: Remember attorney’s fees are deducted first, then apply the 50% cap across all provider liens; paying one provider in full may violate the cap.
Out-of-network or plan terms: Some benefit plans governed by federal law may assert reimbursement rights under plan documents; review those terms early.
Conclusion
Yes—under North Carolina law, you should get and review itemized bills and lien ledgers before you sign your settlement statement. Providers must supply itemized statements to enforce liens, your attorney’s fee is paid first, and the combined medical provider liens cannot exceed 50% of the net recovery after fees. To protect your share and avoid paying deductibles twice, have your attorney request the documents and finalize all lien amounts before disbursement.
Talk to a Personal Injury Attorney
If you're dealing with medical liens and a pending settlement, our firm has experienced attorneys who can help you understand your options and timelines. Call us 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.
