Short Answer

In North Carolina, you can reimburse yourself for an out-of-pocket ambulance bill from your settlement only after paying attorney fees and resolving all valid medical provider liens and any lawful reimbursement claims. Provider liens (like a hospital’s) are capped by law to protect a portion of your recovery after attorney fees. Whatever remains is your money, and you may use it to repay yourself and address any non-lien bills.

Understanding the Problem

You want to know if, under North Carolina personal injury law, you can pay yourself back from your settlement for an ambulance bill you already covered. You settled with the insurer, and there are provider claims against the settlement (a hospital lien and a health plan claim), plus a separate physical therapy bill without a lien. The decision point is whether you can take reimbursement for the ambulance expense from what remains after required deductions.

Apply the Law

North Carolina allows health care providers to assert liens on personal injury settlements for treatment related to the accident. Your lawyer must first deduct “costs of collection” (attorney fees and case costs). Valid provider liens share the remaining funds, but the total paid to those lienholders cannot exceed 50% of the amount left after attorney fees. Bills without liens are ordinary debts; they do not come off the top of the settlement. Separate reimbursement rights (for example, some employer health plans or public benefits programs) follow their own rules and can affect your net recovery. The attorney’s trust account is the usual forum for verifying, negotiating, and paying liens and claims before releasing funds to you.

Key Requirements

• Valid lien: A provider must properly assert a lien for accident-related services, including giving notice and itemized charges on request; otherwise, it is treated like a regular bill.
• Attorney fees first: Reasonable attorney fees and case costs are paid before any provider liens.
• 50% lien cap: The combined payout to health care provider lienholders cannot exceed 50% of what remains after attorney fees are deducted.
• Non-lien bills: Unsecured medical bills (like a physical therapy bill with no lien) are payable from your share, not before liens.
• Other reimbursement claims: Some health plans or public programs may claim repayment under separate rules; confirm whether those claims apply and their priority.
• Your reimbursement: You may reimburse yourself for an ambulance bill you paid once fees and valid liens/claims are resolved and the remaining funds are released to you.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Health care provider liens) - Allows certain providers to claim a lien for accident-related services and requires itemized charges on request.
• North Carolina Gen. Stat. § 44-50 (Distribution and cap) - Attorney fees come first; total provider liens are limited to 50% of the amount remaining after fees.

Analysis

Apply the Rule to the Facts: Your hospital lien must be addressed from the settlement after attorney fees, and the total paid to all provider lienholders cannot exceed 50% of the post-fee amount. The health insurer’s claim needs to be verified; if it is a repayable claim under its plan or applicable law, it may affect your net, but it is not a provider lien under the 50% cap. The physical therapy bill without a lien is paid, negotiated, or disputed from your share. Once those items are resolved, you can reimburse yourself for the ambulance bill from the remaining funds.

Process & Timing

1. Who files: Your attorney (or you, if unrepresented) confirms liens/claims with each provider/plan. Where: Attorney trust account in North Carolina. What: Request itemized statements; prepare an itemized settlement statement for signature. When: After settlement funds clear; verification and negotiation typically take 2–6 weeks, depending on provider response.
2. Pay attorney fees and case costs, then resolve valid provider liens up to the 50% cap; confirm any health plan or public benefit reimbursement rights and settle them as required.
3. Release the remaining balance to you with a final written accounting; you may use your balance to reimburse the ambulance payment and handle the non-lien physical therapy bill.

Exceptions & Pitfalls

• Some employer self-funded health plans and public benefits programs have separate reimbursement rights that are not limited by the 50% provider-lien cap.
• If a provider cannot produce an itemized statement on request, its lien may be unenforceable—use this to negotiate before paying.
• Confirm that the ambulance account shows a $0 balance if you already paid, so it is not paid twice from the settlement.
• Assignments of benefits or treatment agreements you signed can create contract claims even if a statutory lien is weak.
• Reimbursing yourself before clearing liens/claims can lead to demand letters or collections; wait for a final accounting.

Talk to a Personal Injury Attorney

If you’re sorting out liens, health plan reimbursement, and out-of-pocket bills after a settlement, our firm can help you understand your options and timelines. Reach out 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.