Short Answer

In North Carolina, a valid EMS (ambulance) lien attaches to your personal injury settlement and must be paid or resolved from the settlement before you receive funds. Your attorney must disburse to lienholders after attorney’s fees, and all medical liens together cannot take more than 50% of the net settlement after those fees. If EMS can retro-bill your health insurer and it pays, the lien drops to any remaining patient responsibility. If there’s a dispute, your lawyer can hold the disputed amount until it’s resolved or ask a court to decide.

Understanding the Problem

You’re asking, under North Carolina personal injury law, whether and how an EMS provider’s lien affects your settlement when the EMS bill hasn’t been processed by your health insurer. Here, EMS filed a third-party lien but didn’t bill your insurer because it lacked your coverage information. You want to know if you should push EMS to bill your insurance now or pay the lien from the settlement so your attorney can disburse funds.

Apply the Law

North Carolina law gives medical providers, including EMS, a lien on your personal injury recovery for reasonable charges related to your injury care. To enforce it against settlement funds, the provider must give proper written notice and an itemized statement before disbursement. Your attorney must protect valid liens and pay them from the settlement after paying the attorney’s fee. All medical liens combined are capped at 50% of the net settlement after the attorney’s fee, with pro rata sharing if there isn’t enough to pay everyone in full. Disputes can be resolved by agreement or by a court.

Key Requirements

• Valid lien + notice: EMS has a lien on your recovery if it treated you for the accident and provides written notice with an itemized bill before funds are disbursed.
• Attorney’s duty to disburse: Your lawyer must hold settlement funds in trust and pay valid liens before sending you your share.
• Attorney’s fee first: The attorney’s fee comes off the top; by statute, the fee used for lien calculations is capped.
• 50% cap on medical liens: After the attorney’s fee, all medical liens together cannot take more than 50% of the remaining settlement; if liens exceed that, they share pro rata.
• Insurance coordination: If EMS retro-bills your health plan and it pays, the lien must be reduced to your plan-allowed patient responsibility (no lien for amounts paid or contractually written off).
• Forum for disputes: If you can’t agree on the lien amount or distribution, a North Carolina trial court can decide.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien on personal injury recoveries) - Creates the lien for providers like EMS and requires notice and itemization.
• North Carolina Gen. Stat. § 44-50 (Enforcement; attorney’s fee; 50% cap) - Pays attorney’s fee first and caps combined medical liens at 50% of the net after that fee.

Analysis

Apply the Rule to the Facts: EMS treated you after the crash and filed a lien, so it likely has a valid claim on your settlement. Your lawyer must not disburse to you until that lien is satisfied or resolved, but the total paid to all medical lienholders cannot exceed 50% of the net after the attorney’s fee. Asking EMS to retro-bill your health insurer can reduce what is owed from the settlement to only your plan-allowed patient share; if retro-billing isn’t possible, your lawyer can negotiate reductions and apply the statutory 50% cap.

Process & Timing

1. Who files: Your personal injury attorney. Where: Usually handled in the attorney’s trust account; if contested, file a civil action in the North Carolina trial court (typically Superior Court) where services were provided. What: Obtain EMS’s written lien notice and itemized charges; send your insurance information; request retro-billing; calculate the statutory cap. When: Do this immediately after settlement but before any disbursement; health plans often have firm claim-filing deadlines.
2. If EMS retro-bills and your insurer pays, get a revised balance showing your patient responsibility; expect several weeks for processing and any appeal if needed; timing can vary by county and plan.
3. If EMS won’t reduce or retro-bill, your attorney applies the 50% cap and negotiates pro rata payments with all lienholders. If disagreement persists, the attorney can hold only the disputed amount in trust and ask the court to determine the proper payout; then disburse per agreement or order.

Exceptions & Pitfalls

• Government payers: Medicare, Medicaid, or the State Health Plan have separate repayment rules that can supersede provider liens; flag these early.
• Unperfected liens: If EMS does not give proper written notice and itemization before disbursement, its lien rights may be limited—but the underlying bill can still be owed.
• Overstated balances: Providers cannot lien for amounts already paid by insurance or for contractual write-offs; insist on updated itemized statements.
• Distribution errors: Disbursing before resolving liens can expose you and your attorney to claims; keep disputed amounts in trust until resolved.

Talk to a Personal Injury Attorney

If you're dealing with an EMS lien that’s holding up your North Carolina injury 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.