Short Answer

In North Carolina, ask the health plan’s recovery administrator in writing for an updated or final, itemized subrogation lien. Include your client’s identifiers, date of loss, claim/reference number, and a signed HIPAA authorization. You must resolve valid statutory or contractual reimbursement claims (for example, Medicare, Medicaid, the State Health Plan, and provider liens) before disbursing settlement funds. Confirm any phone discussions with a written follow‑up and keep records.

Understanding the Problem

You’re a North Carolina personal injury attorney who already opened a recovery file with the health plan’s subrogation agent, provided client details, and received a case reference number. Now you need to request an updated or final lien amount to safely settle and disburse funds. The question is: how do I request it so the plan audits its file and issues an itemized balance I can rely on?

Apply the Law

North Carolina law requires attorneys to honor valid reimbursement and lien rights before distributing settlement proceeds. Certain payers have statutory recovery rights (Medicare and Medicaid) or specific North Carolina statutes (the State Health Plan), and medical providers may assert liens subject to state rules. The primary forum is administrative—through each plan’s recovery unit—rather than a court, but repayment timelines in demand letters can be short, and interest can accrue if late. Request an itemized statement and dispute unrelated charges promptly.

Key Requirements

• Clear written request: Send a dated letter or secure portal request to the plan’s recovery agent asking for an updated or final, itemized lien.
• Complete identifiers: Include client name, member ID/date of birth, date of loss, plan/policy number, recovery case/reference number, and your contact details.
• Authorization: Attach a current HIPAA authorization so the plan can release itemized billing and lien details to you.
• Itemization and scope: Ask for a breakdown of accident-related payments only, and dispute non‑related or duplicate charges in writing.
• Settlement notice: If settlement is anticipated or reached, notify the plan and request its “final” amount with payoff and remittance instructions.
• Priority and caps: Account for statutory recovery rights (Medicare, Medicaid, State Health Plan) and North Carolina provider lien rules before disbursement.

What the Statutes Say

• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - The State Health Plan has statutory subrogation and recovery rights.
• North Carolina Gen. Stat. § 108A-57 (Medicaid subrogation and liens) - Medicaid may assert a lien and seek reimbursement from liable third-party recoveries.
• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Grants providers a lien for reasonable and necessary medical charges related to the injury.
• North Carolina Gen. Stat. § 44-50 (Attorney’s fees; distribution cap) - Addresses attorney’s fees and caps the portion of settlement available to satisfy provider liens.

Analysis

Apply the Rule to the Facts: You already opened the recovery file and have a reference number. Send a written, HIPAA‑supported request to the recovery agent asking for an updated or final, itemized lien tied to that reference. Specify the accident date and that you need only accident‑related charges. If settlement is imminent or complete, state the expected settlement date and request a final payoff with payment instructions so you can satisfy the lien before disbursing funds.

Process & Timing

1. Who files: The injured person’s attorney. Where: The health plan’s recovery administrator or contractor (via its portal, secure email, or address on its lien notice). What: A written request for an “updated” or “final” itemized lien plus a signed HIPAA authorization. When: Request 2–4 weeks before anticipated settlement and again immediately after settlement for a “final” amount.
2. Upon receipt, the plan audits payments and issues an updated/final lien with remittance instructions. Timelines vary; follow up if you have not heard back within 10–15 business days.
3. Review, dispute any non‑related charges in writing, then pay the valid lien per the instructions. Keep proof of payment for your trust account records and closing file.

Exceptions & Pitfalls

• Medicare, Medicaid, and the State Health Plan have statutory recovery rights; some are not limited by provider‑lien caps. Account for their priority before paying others.
• Do not rely on a phone update alone; confirm and retain a written, itemized statement tied to the correct case reference.
• Dispute unrelated or duplicate charges promptly and in writing; ask for corrected statements before paying.

Talk to a Personal Injury Attorney

If you’re resolving health plan reimbursement on a North Carolina injury settlement, our firm can help you understand lien priorities, challenge unrelated charges, and meet payoff deadlines. Call us today.

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.