Short Answer

In North Carolina, your medical bills can still be paid even if you did not sign an assignment of benefits. Hospitals, doctors, and ambulance services have a statutory lien on any personal injury settlement, and the total amount paid to all providers is capped at 50% of your recovery after attorney’s fees. Your attorney can collect itemized bills, resolve valid liens, and pay providers from the settlement. If Medicare or Medicaid applies, their claims must be addressed before funds are disbursed.

Understanding the Problem

You want to know how to make sure your medical bills get paid in North Carolina when you did not sign an assignment of benefits at the hospital. You are pursuing a bodily injury claim for neck and back pain after a car crash, and you were taken by ambulance to the emergency room for CT scans and x-rays. The core issue is whether providers can still be paid and how payment works without that assignment.

Apply the Law

North Carolina law gives medical providers a lien on personal injury recoveries, which allows them to be paid from your settlement even without an assignment of benefits. An assignment of benefits is just one way a provider can get paid directly by an insurer; it is not the only path. Providers’ lien rights are limited by statute, attorney’s fees are paid first, and the total for all provider liens cannot exceed a set portion of your recovery. If Medicaid or Medicare is involved, those programs have their own reimbursement rules that must be satisfied before you receive settlement funds. Most of this happens outside of court through your attorney’s trust account and the providers’ billing offices.

Key Requirements

• Provider lien exists: Hospitals, physicians, and ambulance services have a lien on personal injury settlement funds for reasonable charges related to your injuries.
• Itemized billing and records: To enforce a lien, providers must furnish itemized statements and related records upon request so you and your attorney can verify charges.
• Attorney’s fees priority: Your attorney’s fees and case expenses are paid first; provider liens are paid from the remaining funds.
• 50% cap on provider liens: The total paid to all medical providers from your recovery is capped at 50% after attorney’s fees, with prorated sharing if liens exceed the cap.
• Public benefit payors: Medicaid and Medicare must be verified and resolved before disbursement; their recovery processes are separate from provider liens.
• Minors’ bills: Parents are generally responsible for a minor’s medical expenses; settlement approval and how bills are paid can require extra steps, which can affect timing.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical providers’ lien) - Creates a lien for reasonable medical charges on personal injury recoveries.
• North Carolina Gen. Stat. § 44-50 (Distribution and cap) - Prioritizes attorney’s fees and caps total provider lien payments at 50% of the recovery after fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien and procedures) - Sets Medicaid’s lien and procedures for determining and resolving its share.

Analysis

Apply the Rule to the Facts: Because you took an ambulance to the ER and had imaging, those providers can assert liens on any bodily injury settlement tied to your crash. Even without an assignment of benefits, your attorney can request itemized bills, verify charges, and pay valid liens from the settlement after attorney’s fees. If you have Medicaid or Medicare, those claims must be confirmed and resolved before paying providers; if you have private health insurance, your attorney will coordinate benefits and address any plan reimbursement claims according to the plan terms and applicable law. If any of your children were injured, your attorney will address who is responsible for their medical bills and any required approval before disbursing funds.

Process & Timing

1. Who files: You or your attorney. Where: Providers’ billing offices; your auto insurer (for medical payments coverage); your health insurer; and, if applicable, Medicaid/Medicare recovery units. What: Submit claim forms, HIPAA-compliant authorizations, and request itemized statements and lien balances. When: Start immediately after treatment to avoid collections and to preserve insurance benefits.
2. Verification and negotiation: Providers send itemized bills and lien balances; your attorney verifies accident-related charges, checks any insurance payments or write-offs, and negotiates within the 50% cap where applicable. Timeframes vary by provider and insurer.
3. Disbursement: After settlement, funds go to the attorney trust account. Attorney’s fees and costs are paid first, then valid liens (subject to the cap), then the client. You receive a closing statement and proof of payments to providers.

Exceptions & Pitfalls

• No assignment signed: You still owe the bills; use a letter of protection from your attorney to pause collections while the injury claim is pending.
• Records and itemization: If a provider will not supply itemized bills or records upon request, it can affect lien enforceability; document all requests.
• Using med pay: If you receive med pay funds directly, set them aside for bills—spending them before resolving balances can create avoidable debt and credit issues.
• Public benefits: Medicare and Medicaid must be resolved before disbursement; delays are common, so start early to avoid holding up your settlement.
• Minor claims: Settlements for injured minors may require court approval and special handling of funds, which can delay when providers are paid.
• Double billing: Make sure providers bill health insurance first when available; overpayments later can be hard to unwind.

Talk to a Personal Injury Attorney

If you're dealing with medical bills after a car crash and didn’t sign an assignment of benefits, 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.