Short Answer

Under North Carolina law, your attorney must first pay attorney’s fees/costs and any properly perfected medical liens from the settlement, subject to a statutory cap. A physical therapy bill without a perfected lien is not automatically paid from the settlement. If funds run out, the non-lien bill remains your personal debt—you can negotiate a reduction or payment plan, but the provider may pursue collection if unpaid.

Understanding the Problem

You want to know what happens to a physical therapy bill when there is no perfected lien on your North Carolina personal injury settlement. You settled your claim and still owe a non-lien therapy balance. The question is whether that bill must be paid from your recovery, and what your options are if the settlement won’t cover it.

Apply the Law

North Carolina gives certain medical providers a statutory lien against personal injury recoveries, but only if the lien is properly perfected and only up to a capped share of the settlement after attorney’s fees. A provider without a perfected lien has no statutory claim on the settlement funds held for disbursement. That type of bill is treated like any other personal debt and can be negotiated or paid by the patient directly. Disbursement typically occurs through the attorney trust account; disputes about unpaid balances are handled by negotiation or, if necessary, civil collection in court. A general three-year statute of limitations applies to most medical debts and written contracts in North Carolina.

Key Requirements

• Perfection matters: A provider must give timely written notice and an itemized statement to assert a medical lien on a personal injury recovery.
• Priority and cap: Attorney’s fees and costs come off the top; total medical lien payments are capped by statute at a portion of the recovery.
• Non-lien bills: If a provider did not perfect a lien, they cannot compel payment from the settlement; the patient remains responsible for the balance.
• Reimbursement of out-of-pocket expenses: Documented medical expenses you personally prepaid (like an ambulance bill) can be reimbursed to you after fees and perfected liens are handled.
• Forum and timing: Disbursement occurs via the attorney trust account; unresolved non-lien balances are subject to ordinary billing/collection and general debt limitation periods.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical liens on personal injury recoveries) - Allows certain providers to claim a lien if they give proper notice and documentation.
• North Carolina Gen. Stat. § 44-50 (Lien cap and attorney fee priority) - Caps total medical liens and gives attorney’s fees priority before lien payments.
• North Carolina Gen. Stat. § 1-52 (Three-year limitations for contract/medical debt) - Sets the general three-year deadline for most contract-based debt claims.

Analysis

Apply the Rule to the Facts: Your therapy provider did not perfect a lien, so your attorney is not required to pay that bill from the settlement. After attorney’s fees/costs and any properly perfected liens (including the hospital’s) are paid within the statutory cap, any remaining funds can address other items, such as reimbursing you for the ambulance bill you prepaid. If there is not enough left to cover the non-lien therapy balance, that bill remains your personal responsibility and can be negotiated.

Process & Timing

1. Who files: No court filing is required. Where: Disbursement occurs through your attorney’s trust account in North Carolina. What: Confirm whether the therapy provider perfected a lien by requesting a written, itemized statement and lien notice. When: Do this before funds are disbursed to avoid surprises.
2. Ask the therapy provider for an itemized bill and propose a reduction or payment plan in writing. Providers often respond within 2–4 weeks, though timing varies by office.
3. Your attorney disburses: pay fees/costs, then perfected liens within the cap, then reimburse your documented out-of-pocket medical payments, and finally release remaining funds to you. Finalize any therapy payment plan directly with the provider and keep a written agreement.

Exceptions & Pitfalls

• Certain payors (for example, government programs or qualifying ERISA plans) may have separate reimbursement rights that do not depend on a state lien; confirm the nature of each claim.
• Do not assume “no lien” means “no obligation.” Unpaid balances can go to collections and affect credit.
• Get any discount or payment plan in writing; verbal agreements are easy to dispute later.
• Verify lien status before disbursement. A late-arriving lien notice can change the payout order if received in time.
• Do not pay non-lien bills ahead of perfected liens; that can violate the statutory cap and create disputes.

Talk to a Personal Injury Attorney

If you’re dealing with a settlement that will not cover a non-lien medical bill, our firm has experienced attorneys who can help you understand your options and timelines. Reach out 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.