Short Answer

In North Carolina, medical providers can assert a lien against a personal injury recovery if they follow the lien rules. You may refuse to pay a provider lien when it is not properly perfected, is unlawfully inflated, or is barred by the provider’s insurance contract (for example, failure to timely bill your health plan when required). Attorney’s fees are paid first (up to one‑third), and valid provider liens together cannot take more than 50% of the remaining recovery.

Understanding the Problem

In North Carolina, can you tell a physical therapy clinic not to take money from your personal injury settlement when it did not send one date of service to your health insurer on time? You are deciding whether to pay that clinic from the settlement or insist the clinic remove its lien, while your attorney fees and other liens are paid under the normal priority rules.

Apply the Law

North Carolina law gives certain health care providers a lien on personal injury settlements if they follow specific steps. These liens are subject to strict caps and distribution rules. The settlement is disbursed by your attorney, who must honor valid liens after deducting the attorney’s fee. Disputes about lien validity or amount can be resolved in the Superior Court if negotiation fails.

Key Requirements

• Covered provider: The lien is available to providers that furnish medical or health care services for injury treatment (this includes physical therapy).
• Perfection by notice and cooperation: The provider must give written notice of the lien amount and, upon request, promptly provide itemized charges and relevant records without charge; failure to furnish on request can void the lien.
• Priority and caps: Your attorney’s fee (up to one‑third) is paid first; all valid provider liens together are then limited to no more than 50% of the remaining settlement, shared fairly among providers.
• Reasonableness and contract limits: Providers generally cannot collect more than lawful, contractually permitted charges; in‑network agreements and timely‑filing rules can limit or bar what a provider may collect from you.
• Different rules for health plans: Health insurer “subrogation/reimbursement” claims (often handled by Optum) arise from plan contracts and are not the same as provider liens; Medicare, Medicaid, or the State Health Plan have separate statutory rights and timelines.

What the Statutes Say

• North Carolina Gen. Stat. § 44‑49 (Medical provider lien) - Creates a lien for medical providers and conditions it on providing itemized bills/records upon request.
• North Carolina Gen. Stat. § 44‑50 (Distribution and caps) - Attorney’s fee priority (up to one‑third) and a 50% cap on total provider liens from the remainder, with pro rata sharing.
• North Carolina Gen. Stat. § 108A‑57 (Medicaid lien) - Sets Medicaid’s recovery rights from third‑party settlements.
• North Carolina Gen. Stat. § 135‑48.37 (State Health Plan subrogation) - Describes the State Health Plan’s reimbursement rights.

Analysis

Apply the Rule to the Facts: The physical therapy provider is a covered provider, so it can have a lien only if it properly perfects it by giving written notice and providing itemized charges/records upon request. Because it failed to timely bill your health insurer for one service date, your attorney should check whether the clinic’s network contract or plan rules bar collecting from you; if so, the lien for that date can be disputed or denied. Regardless, your attorney fee comes off the top, and all valid provider liens combined cannot take more than 50% of the remainder, which must be shared pro rata. Optum’s subrogation claim is separate and depends on the health plan’s contract and applicable law.

Process & Timing

1. Who files: Your personal injury attorney. Where: North Carolina Superior Court (civil division) in the county tied to the claim, if a court ruling is needed. What: A demand letter to the provider first (requesting billing to the health insurer or a written lien reduction/release); if unresolved, a civil action such as interpleader or a motion to determine lien validity and distribution. When: Before disbursing settlement funds.
2. Your attorney gathers the provider’s itemized bill and records, verifies lien perfection, calculates the statutory cap after attorney’s fees, and requests network/plan terms to confirm any required write‑offs. Expect 2–6 weeks for records and negotiations; timelines vary by county and provider.
3. If the dispute persists, your attorney holds the disputed amount in trust and seeks a court order allocating the settlement among liens and you. The outcome is a court order or written releases confirming the final distribution.

Exceptions & Pitfalls

• Medicare, Medicaid, and the State Health Plan follow separate statutory rules; do not assume the 50% provider‑lien cap applies to them.
• If a provider does not promptly furnish itemized charges or records after a request, its lien can be void; make the request in writing and keep proof.
• In‑network providers that miss timely‑filing deadlines may be unable to balance‑bill you under their contracts; use this to seek lien removal or reduction.
• Do not ignore written lien notices; attorneys can face liability for disbursing funds without addressing valid liens. Keep disputed funds in the trust account until resolved.
• Health insurer subrogation (e.g., Optum) is contractual and distinct from provider liens; rights and reductions depend on plan terms and applicable law.

In North Carolina, you can refuse to pay a medical lien if the provider did not perfect it, the amount exceeds lawful caps, or the provider’s insurance contract bars collection because it failed to bill your health plan. Your attorney’s fee is paid first (up to one‑third), and all valid provider liens together cannot exceed 50% of the remaining settlement. Next step: have your attorney demand billing to the health insurer or a written lien reduction/release and, if needed, seek a Superior Court order before disbursing funds.

Talk to a Personal Injury Attorney

If you're dealing with medical liens on a North Carolina injury settlement and a provider failed to bill your health plan, 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.