Short Answer

Yes—under North Carolina law, valid medical liens and certain government or health-plan reimbursement claims must be resolved from your personal injury settlement before funds are paid to you. Doctors, hospitals, and ambulance services can assert statutory liens if they give proper written notice and itemized charges, and those liens are capped in total at 50% of the recovery after attorneys’ fees. Separate rules require repayment to Medicare and Medicaid, and the State Health Plan may also seek reimbursement.

Understanding the Problem

In North Carolina personal injury cases, the practical question is: if I settle my claim, must I pay back medical providers from the settlement? You were a backseat passenger taken by ambulance to the ER after a crash and you have no health insurance. You want to know whether your eventual settlement must reimburse the ambulance, hospital, and follow-up providers before you receive your share.

Apply the Law

North Carolina gives medical providers a statutory lien on an injured person’s settlement or judgment for reasonable charges related to the injury, if the provider properly perfects the lien by written notice and an itemized statement. Attorneys must protect valid liens before disbursing client funds. As a guardrail, attorneys’ fees (typically up to one-third) are paid first, and the sum of all perfected provider liens cannot exceed 50% of the total recovery after attorneys’ fees. Separate statutes and federal rules require repayment of certain benefit payors, including Medicaid, Medicare, and the State Health Plan; those rights are not governed by the medical-provider 50% cap.

Key Requirements

• Valid medical lien: Hospital, physician, chiropractor, dentist, nurse, ambulance service, or similar provider must give written notice and an itemized statement of charges tied to the injury.
• Scope of lien: The lien attaches to settlement or judgment proceeds from the injury claim, not to unrelated claims.
• Priority and caps: Attorneys’ fees are paid first (typically up to one-third). The total paid to all medical-provider lienholders cannot exceed 50% of the recovery after attorneys’ fees.
• Government/plan payors: Medicaid, Medicare, and the State Health Plan can demand reimbursement for amounts they paid; their rights are enforced separately and are not governed by the 50% provider-lien cap.
• Attorney’s duty: Settlement funds must be held in trust until valid liens and repayment claims are verified, negotiated if appropriate, and paid or resolved.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Creates a lien for certain medical providers that give proper notice and itemized charges.
• North Carolina Gen. Stat. § 44-50 (Payment; attorney’s fee; 50% cap) - Sets priority for attorneys’ fees and limits total provider liens to 50% of the recovery after fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien and recovery) - Authorizes State Medicaid recovery from third-party settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Gives the State Health Plan reimbursement and subrogation rights.

Analysis

Apply the Rule to the Facts: You were transported by ambulance to an ER and have no health insurance. The ambulance and hospital can perfect liens if they send written notice and itemized charges connected to the crash; your lawyer must resolve those before paying you. After attorneys’ fees are paid, the combined payout to all perfected provider lienholders cannot exceed 50% of the remaining recovery. If Medicaid or Medicare paid anything, those programs must be repaid from the settlement under their own rules.

Process & Timing

1. Who files: Medical providers do not file in court; they send written lien notice and itemized bills to you, your attorney, or the insurer. Where: Delivered to your attorney/insurer in North Carolina. What: Written notice plus an itemized statement to perfect the lien under state law. When: Before settlement funds are disbursed; your attorney should collect and verify all lien notices first.
2. Your attorney requests itemized bills, confirms lien perfection, and negotiates reductions if charges are disputed or the 50% cap applies. Government/plan payors (Medicare/Medicaid/State Health Plan) are contacted for updated repayment amounts; timing varies by agency.
3. After attorneys’ fees, your lawyer pays valid perfected liens and required reimbursements from trust, obtains written releases, then disburses your net recovery with a closing statement.

Exceptions & Pitfalls

• If a provider does not properly perfect its lien (no written notice and itemized charges), it may not have a lien on the settlement—though you may still owe the bill personally.
• When total perfected provider liens exceed the 50% cap (after attorneys’ fees), they are typically reduced and paid proportionally up to the cap.
• Medicare and Medicaid must be reimbursed from injury settlements; those recoveries are not subject to the medical-provider 50% cap. The State Health Plan also has separate reimbursement rights.
• Service/notice missteps can invalidate a lien; conversely, ignoring valid liens can delay disbursement and risk interest or penalties from benefit payors.

Talk to a Personal Injury Attorney

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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.