Short Answer

In North Carolina, you start with the gross settlement, subtract your attorney’s fee and case costs, then resolve medical liens and reimbursements. Medical provider liens are generally capped by statute, and certain health plans (like Medicaid, Medicare, and the State Health Plan) follow separate rules. After those legally required payments and any negotiated reductions, the remainder is your take-home amount.

Understanding the Problem

You want to know, under North Carolina law, how to calculate the net amount you will actually receive from a bodily injury settlement after medical coverage is considered. You have a settlement offer on your injury claim, your insurer already paid some medical payments coverage, and you have a minimum net number you’re hoping to clear.

Apply the Law

Under North Carolina law, net settlement is calculated by working in this order: (1) confirm the gross settlement; (2) deduct attorney’s fee and case costs; (3) apply North Carolina’s medical lien rules for providers; and (4) address health plan reimbursement claims (Medicaid, Medicare, State Health Plan, or ERISA plans, as applicable). The primary forum is out-of-court settlement, but you must resolve statutory liens and reimbursements before disbursement. Key thresholds include the cap on provider liens and specific limits or rules for certain health programs.

Key Requirements

• Attorney’s fee and case costs off the top: Deduct the contingency fee and case expenses before paying medical liens; subsequent caps apply to the remainder.
• Medical provider liens apply but are capped: Hospitals and treating providers can assert liens on your recovery, but the total payable to them is limited by statute relative to your recovery after fees.
• Public program reimbursements: Medicaid has a statutory formula with a cap tied to the total recovery; Medicare must be repaid under federal law (subject to procurement cost reductions), and it is not limited by the state provider-lien cap.
• State Health Plan and some self-funded plans: The North Carolina State Health Plan has statutory reimbursement rights; some self-funded ERISA plans may assert separate reimbursement claims that do not follow the provider-lien cap.
• Med Pay interaction: Medical payments coverage can reduce outstanding balances to providers but may create a contractual reimbursement claim; review policy terms.
• Final accounting before disbursement: Get written lien/reimbursement confirmations and reductions documented; then prepare a disbursement statement showing the net to you.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider claims) - Lets medical providers claim a lien on personal injury recoveries if they comply with notice and record requirements.
• North Carolina Gen. Stat. § 44-50 (Lien amount and priority) - Caps the total amount payable to providers at a percentage of the recovery after deducting attorney’s fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) - Requires reimbursement to Medicaid with a statutory limit tied to the recovery.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Grants reimbursement rights to the State Health Plan separate from provider-lien caps.

Analysis

Apply the Rule to the Facts: With a moderate settlement offer and modest medical bills, first deduct your attorney’s fee and case costs. Next, confirm what providers are owed after applying the provider-lien cap to the post-fee amount. Then address any reimbursements: credit the medical payments coverage already issued against outstanding provider balances, and resolve any Medicaid, Medicare, State Health Plan, or plan-based claims. The remaining balance is your net, which you can compare to your stated minimum.

Process & Timing

1. Who files: Your attorney. Where: Not a court filing; handled with the liability insurer, medical providers, and any payers (Medicaid, Medicare, State Health Plan, or private/ERISA plans). What: Request/itemize medical bills and liens; obtain Medicaid/Medicare/plan payoff letters; confirm medical payments coverage and any reimbursement terms. When: Do this before signing the release and before disbursing funds.
2. Apply the statutory cap to provider liens after deducting fees/costs; negotiate reductions where appropriate; reconcile med pay credits; obtain final written payoff/demand from Medicaid/Medicare/plan administrators. This commonly takes a few weeks depending on agency response times.
3. Prepare and review a written settlement disbursement (gross, fees/costs, each lien/reimbursement, and your net); after approvals, disburse funds and close the file.

Exceptions & Pitfalls

• Some health plans (for example, the State Health Plan or certain self-funded ERISA plans) may assert reimbursement outside the provider-lien cap; analyze plan language early.
• If a provider did not comply with statutory lien requirements, its claim may be limited; verify notices and records were properly provided.
• Medicare conditional payments and Medicaid liens must be resolved; failure can trigger interest, penalties, or separate collection.
• Medical payments coverage can reduce provider balances but may carry contractual reimbursement; check your policy and coordinate with the bodily injury settlement.
• Don’t agree to a release before confirming lien/reimbursement totals; you want accurate, final numbers before you commit.

Talk to a Personal Injury Attorney

If you're dealing with a settlement and want to know your true net after medical liens and reimbursements, 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.