Short Answer

In North Carolina, you can usually cover treatment costs before settlement by using your health insurance, making a claim under your own auto policy’s Medical Payments ("Med Pay") coverage, or asking your provider to treat on a lien to be paid from your settlement. The at-fault driver’s insurer rarely pays medical bills as you go and may require a release if it does. Each option has lien and reimbursement rules you must follow to avoid owing twice.

Understanding the Problem

You’re asking, in North Carolina, how you can pay for care now—before your personal injury case resolves—when a physical therapy provider expects payment and you are deciding between out-of-pocket, health insurance, or the at-fault insurer. This question sits at the heart of personal injury law because cash flow, insurance coordination, and lien rules affect both your treatment and your eventual recovery. You’re in the right place to understand what you can use now and what must be repaid later.

Apply the Law

Under North Carolina law, you generally have three practical paths to fund care before settlement: (1) use health coverage (private insurance, Medicare, or Medicaid) and deal with any reimbursement rights later; (2) use your own auto policy’s Med Pay to reimburse you or your provider for accident-related bills, regardless of fault; and (3) ask providers to accept a statutory lien and wait for payment from your settlement, subject to caps and notice rules. The at-fault driver’s liability insurer typically does not pay ongoing bills before you sign a release. If your case goes to court, evidence of past medical bills is limited to amounts actually paid or still owed.

Key Requirements

• Identify available coverage: Confirm health insurance, Medicare/Medicaid eligibility, and whether your auto policy includes Med Pay.
• Respect lien and reimbursement rights: Medical providers, Medicaid, Medicare, and some health plans may have repayment rights from your settlement.
• Use proper notice and documentation: Providers asserting liens must give written notice; you should keep itemized bills, EOBs, and policy documents.
• Avoid premature releases: Do not accept early liability payments that require signing a release before treatment ends.
• Mind deadlines and caps: Insurance policies have notice/proof-of-loss requirements; North Carolina caps total medical provider liens from a settlement and prioritizes attorney fees.

What the Statutes Say

• N.C. Gen. Stat. § 44-49 (Medical providers’ liens) - Allows providers to claim a lien on personal injury recoveries if they give proper notice.
• N.C. Gen. Stat. § 44-50 (Lien limits and attorney priority) - Caps the total of medical liens paid from a settlement and gives the attorney’s fee priority.
• N.C. R. Evid. 414 (Medical expenses evidence) - Limits proof of past medical expenses to amounts actually paid or still owed.
• N.C. Gen. Stat. § 108A-57 (Medicaid lien) - Gives Medicaid a statutory lien and sets procedures for reimbursement from settlements.

Analysis

Apply the Rule to the Facts: Because your physical therapy provider expects payment now, first present your health insurance so treatment continues; you may have to reimburse the plan later depending on the type of plan. Next, make a Med Pay claim under your own auto policy to cover co-pays and balances, regardless of fault. If needed, ask the therapist to accept a lien and wait for payment from your settlement, which will be limited by North Carolina’s lien cap. Avoid relying on the at-fault insurer for ongoing payments before settlement.

Process & Timing

1. Who files: You (or your attorney). Where: Your auto insurer’s claims department and your health insurer. What: Med Pay/medical payments claim form, accident details, itemized bills, and a HIPAA/medical authorization if required. When: Report and submit proof of loss promptly; policy deadlines vary, so act as soon as bills start.
2. Ask your provider to bill health insurance now. If they prefer to wait for settlement, request treatment under a lien ("letter of protection"); the provider should send written lien notice. This setup can be completed within days to a few weeks, depending on the provider.
3. Before settlement disbursement, resolve all liens: verify itemized balances, obtain final demands (Medicaid/Medicare if applicable), apply the lien cap, and document payments from settlement proceeds. Then, your insurer or attorney issues payments and releases funds to you.

Exceptions & Pitfalls

• Medicare/Medicaid must be reimbursed from settlements; failing to resolve these liens can delay payment and affect benefits.
• Some employer health plans (especially self-funded plans) have strong reimbursement rights; get the plan document to confirm obligations.
• If a provider does not properly perfect a lien, they may still bill you directly; coordinate billing to avoid double payment.
• Early payments from the at-fault insurer may come with a broad release—do not sign away your claim before treatment ends.
• Evidence rules limit recoverable medical expenses to amounts actually paid or still owed; using health insurance usually will not harm your claim under this standard.

Talk to a Personal Injury Attorney

If you're dealing with mounting treatment bills while your claim is pending, our firm has experienced attorneys who can help you coordinate Med Pay, health insurance, and liens to keep care on track. 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.