Short Answer

In North Carolina, valid medical provider liens attach to your personal injury recovery. Your attorney must pay perfected liens from the settlement funds before sending you your share. After reasonable attorney’s fees are paid, North Carolina law caps the combined amount paid to medical providers at 50% of the remaining settlement, with pro rata sharing if needed. Government program claims (like Medicare or Medicaid) follow separate rules and must be satisfied.

Understanding the Problem

Under North Carolina personal injury law, you want to know who pays medical liens after your case settles. You are the injured person, your case has resolved, and your lawyer is asking providers for final lien amounts. The decision point is whether the settlement must be used to satisfy medical liens, and if so, how much and by whom.

Apply the Law

North Carolina gives medical providers a lien on personal injury recoveries if they follow the statutory steps. A “medical lien” is a legal claim against your settlement for the value of care related to the injury. Your lawyer disburses settlement funds from a trust account, pays perfected liens required by law, and then distributes the balance to you. After paying a reasonable attorney’s fee, the total paid to medical lienholders cannot exceed 50% of the remaining settlement. If that cap applies, lienholders are paid pro rata. Government healthcare payers (Medicare, Medicaid, and the State Health Plan) have their own repayment rules and priority.

Key Requirements

• Valid lien and notice: A provider must properly assert its lien and provide itemized statements and records upon request to claim settlement funds.
• Attorney’s trust disbursement: Your attorney must use settlement funds to pay perfected liens and mandated reimbursements before distributing your share.
• Fee-first, then 50% cap: Reasonable attorney’s fees come off the top; provider liens together cannot exceed 50% of the remaining settlement and share pro rata if there is not enough.
• Government claims honored: Medicare, Medicaid, and the State Health Plan have separate statutory rights that must be repaid and can affect how much is available to other providers.
• Disputes handled before disbursement: If there is a dispute about amounts or priority, your lawyer should hold funds in trust and seek resolution, including court guidance if needed.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Creates a lien on personal injury recoveries for reasonable medical charges when statutory steps are followed.
• North Carolina Gen. Stat. § 44-50 (Distribution; attorney’s fees; cap) - Requires payment of liens from settlement, allows attorney’s fee first, and caps combined provider liens at 50% of the remainder with pro rata sharing.
• North Carolina Gen. Stat. § 108A-57 (Medicaid third-party recovery) - Sets Medicaid’s reimbursement rights from liability settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Establishes the State Health Plan’s recovery rights when a third party is responsible.

Analysis

Apply the Rule to the Facts: Your case has settled, and your attorney is requesting final lien amounts. Under North Carolina law, the attorney will collect itemized bills, verify perfected liens, and pay those claims from the settlement before disbursing your funds. After paying a reasonable attorney’s fee, providers as a group cannot receive more than 50% of the remainder and must share pro rata if needed. If Medicare or Medicaid paid for your treatment, those claims must be resolved as required before money is released to you.

Process & Timing

1. Who files: Typically your attorney. Where: The law firm’s trust account; disputes may be brought in the Superior Court for your North Carolina county. What: Written requests for itemized statements/records; confirmation of lien notices; verification of any Medicare/Medicaid/State Health Plan claims. When: Before any settlement funds are disbursed to you.
2. Your attorney confirms the reasonable fee, applies the statutory 50% cap to provider liens after fees, seeks appropriate reductions, and ensures government program claims are satisfied. Timeframes vary by provider and agency.
3. If any lien remains disputed, your attorney holds that portion in trust and may seek agreement or ask the court for instructions. Once resolved, the attorney issues a settlement statement and disburses your net funds.

Exceptions & Pitfalls

• Unperfected liens: If a provider does not comply with lien requirements (including providing itemized statements upon request), it may lack lien rights against the settlement, though the bill may still be owed.
• Overpaying providers: Do not exceed the 50% post-fee cap; when funds are short, pay providers pro rata as the statute requires.
• Government recoveries: Medicare, Medicaid, and the State Health Plan have separate statutory rights; failing to resolve them can delay payment or trigger penalties.
• Release timing: Do not release client funds until lien amounts are verified in writing and any disputes are resolved or properly reserved in trust.
• Communication gaps: Ensure providers send final itemized statements; lack of documentation can stall settlement disbursement.

Talk to a Personal Injury Attorney

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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.