Short Answer

In North Carolina, your attorney’s fee comes off the top, and medical provider liens are then paid—but all providers together cannot take more than 50% of your recovery after attorney’s fees. A provider’s lien still can exist even if it failed to bill health insurance on time, but that failure can be a strong basis to negotiate reduction or withdrawal. Medicaid, Medicare, and certain health plans have separate recovery rules that may sit outside the provider lien cap.

Understanding the Problem

In North Carolina personal injury cases, can you be forced to pay a physical therapy bill from settlement funds when the provider missed a billing deadline and filed a lien anyway? You have a settlement with multiple liens, and one PT date of service was not timely submitted to insurance. You want to know if you should pay that lien out of pocket or push the provider to remove it.

Apply the Law

North Carolina law gives medical providers a lien on personal injury settlements if they furnish medical services for accident-related injuries. After the attorney’s fees and case costs are paid, provider liens are paid next, but the total paid to all providers from the settlement is capped at a percentage of the net recovery. Providers must support their liens with itemized charges and records on request, and they must share in reductions when the cap applies. Disputes about who gets paid, and how much, are resolved in the civil division of Superior Court if negotiation fails.

Key Requirements

• Valid provider lien: The charges must relate to accident care, and the provider must give sufficient notice and itemized statements/records on request.
• Attorney’s fee first: Your lawyer’s reasonable fee and case costs are paid before medical liens.
• 50% cap on providers: All provider liens together cannot exceed 50% of the settlement after attorney’s fees are deducted; if there isn’t enough to pay all in full, they are paid pro rata.
• Plan reimbursement is different: Medicaid, Medicare, the State Health Plan, and certain ERISA/self-funded plans pursue statutory or contractual reimbursement that may not be limited by the provider-lien cap.
• Court backstop: If providers or plans won’t agree, a judge can decide priority and amounts before funds are disbursed.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Creates liens for accident-related medical services and requires cooperation with requests for itemized statements/records.
• North Carolina Gen. Stat. § 44-50 (Payment and priority) - Attorney’s fees come first; providers are capped to a portion of the net and share pro rata if funds are short.
• North Carolina Gen. Stat. § 108A-57 (Medicaid third-party recovery) - Sets Medicaid’s recovery rights and limits from third-party settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Establishes the State Health Plan’s reimbursement rights outside the provider-lien cap.

Analysis

Apply the Rule to the Facts: Your lawyer’s 33.5% fee is paid first. The remaining funds are subject to the medical provider-lien cap, so all providers together cannot take more than 50% of the net after that fee. The PT’s missed billing date does not automatically void its lien, but it is strong leverage: if the PT had an in-network contract requiring timely billing, that contract may bar collecting from you for that date, making withdrawal or reduction appropriate. OPTUM’s subrogation (often tied to a health plan) may be handled under separate plan or statutory rules and may not be capped like provider liens.

Process & Timing

1. Who files: The injured person through counsel. Where: Negotiation first; if unresolved, file in North Carolina Superior Court (civil division) in your county. What: Your attorney gathers itemized statements, plan documents, and claim files; applies the lien cap; and proposes pro rata reductions. When: This typically occurs immediately after settlement but before funds are disbursed.
2. Your attorney negotiates with each provider and any plan (e.g., OPTUM) for reductions and confirms that any provider who missed timely insurance billing will honor its network obligations or withdraw the disputed charge.
3. If a dispute remains, your attorney can hold the disputed amount in trust and seek a court order adjudicating lien validity, priority, and pro rata distribution; the court’s order authorizes final disbursement.

Exceptions & Pitfalls

• If a provider refuses to supply itemized charges/records on request, you can challenge the lien’s enforceability until adequate support is provided.
• In-network providers who miss plan filing deadlines may be contractually barred from billing you; ask for withdrawal or a write-off of that date of service.
• Medicare, Medicaid, State Health Plan, and some ERISA/self-funded plans may not be subject to the provider-lien cap—coordinate reductions separately and don’t disburse until their claims are resolved.
• When funds are short, providers must accept pro rata payment under the cap; paying one provider in full can create disputes—insist on a global, documented split.
• Have your lawyer escrow disputed amounts and, if needed, seek a court ruling before release to avoid double-payment risk.

Talk to a Personal Injury Attorney

If you're facing competing medical liens or a disputed charge after settlement, our firm has experienced attorneys who can help you understand your options and timelines. Call us today to discuss your case.

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.