Short Answer

In North Carolina, providers can keep billing you while your injury claim is pending, and some may send accounts to collections. But state law gives them a lien against your settlement or judgment for reasonable injury-related charges, and your attorney must address valid liens before disbursing funds. The total of all medical provider liens is capped at 50% of your net recovery after attorney’s fees, and providers share pro rata within that cap. Government payers (Medicaid, Medicare, State Health Plan) have separate repayment rules that must be resolved at settlement.

Understanding the Problem

You’re asking: in North Carolina, can my doctors and hospitals keep billing or sending my account to collections before my bodily injury settlement is paid, and what does that mean for me? You were hurt recently, hired a firm, and you’re getting collection demands while you prepare a demand letter to the insurer.

Apply the Law

North Carolina law allows medical providers to assert a statutory lien on a personal injury settlement or judgment for reasonable and necessary charges related to the injury. Your lawyer must resolve valid liens out of the settlement, from the attorney trust account, before distributing money to you. The combined provider liens cannot exceed 50% of your net recovery after deducting attorney’s fees. Public benefit payers (like Medicaid) and some health plans have distinct repayment rights that your lawyer must also address before disbursement.

Key Requirements

• Covered charges: The lien applies to reasonable, injury-related medical bills from licensed providers.
• Attachment to recovery: The lien attaches to money you recover from the at-fault party; it does not bar providers from billing you before settlement.
• Attorney’s duties: Your attorney must identify, verify, and pay valid liens from the settlement held in trust before paying you.
• 50% cap on provider liens: All provider liens together cannot exceed 50% of your net recovery after attorney’s fees; providers share pro rata within that cap.
• Government/plan repayment: Medicaid, the State Health Plan, and Medicare have separate statutory or federal reimbursement rules that may not be limited by the 50% cap and must be resolved before funds are released.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Providers have a lien on personal injury recoveries for reasonable charges.
• North Carolina Gen. Stat. § 44-50 (Enforcement and 50% cap) - Sets enforcement rules and limits combined provider liens to 50% of net recovery after attorney’s fees, with pro rata sharing.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) - Establishes Medicaid’s repayment rights and allocation rules.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Provides the State Health Plan’s recovery rights when a third party is liable.

Analysis

Apply the Rule to the Facts: Because you are receiving bills and collection demands, your attorney should immediately notify each provider of representation and request a temporary hold. Those providers may keep billing, but their leverage is the lien on your settlement, which your attorney must evaluate and pay from trust before you receive funds—subject to the 50% cap after attorney’s fees, shared pro rata. Therapy or counseling charges for your anxiety are medical bills and will be treated the same way. Your out-of-pocket auto deductible and replacement vehicle costs are separate property-damage items your attorney can include in negotiations, not medical liens.

Process & Timing

1. Who files: You/your attorney. Where: Directly with providers, health plans, and the liability insurer; no court filing is required to assert or honor liens. What: Provide all bills, EOBs, and collection letters; authorize releases; request itemized final statements; ask providers for a hold letter and to bill health insurance if available. When: Do this as soon as bills arrive and again before sending the demand.
2. After settlement, your attorney obtains final lien amounts, verifies reasonableness, and negotiates reductions when appropriate. Government and plan payers (Medicaid/State Health Plan/Medicare) require separate verification and repayment calculations before disbursement.
3. The insurer issues the settlement check to your attorney’s trust account. Your attorney pays validated liens and required reimbursements, then issues you the balance with a written settlement statement showing each payment.

Exceptions & Pitfalls

• Some providers lose lien rights against your settlement if they do not follow statutory requirements; however, they may still pursue you as a regular debtor. Have your attorney evaluate compliance.
• Medicaid, State Health Plan, and Medicare have distinct repayment rules and formulas. These must be resolved before funds are released and may not be limited by the 50% provider cap.
• Do not sign broad payment promises or assignments that conflict with lien limits. Route all collection calls to your attorney and keep copies of every bill and notice.
• If sued on a medical bill, notify your attorney immediately; court judgments can complicate settlement and timing of disbursement.

Talk to a Personal Injury Attorney

If you're dealing with aggressive medical billing and collections while your injury claim is pending, 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.