Warner Robins, GA
You need treatment, you have no health insurance or MedPay, and the at-fault insurer will not pay until the claim settles. A letter of protection bridges that gap. Here is how it works in North Carolina and what to watch for.
Also called: LOP, attorney lien letter, treatment on a lien
Injury claims take months or years to resolve, but injuries need treatment now. When an injured person has no health insurance, no MedPay, or a provider that will not bill insurance for crash-related care, the treatment often stops unless someone guarantees payment. A letter of protection is that guarantee. The attorney promises the provider that its bill will be paid out of the settlement or judgment before the client receives any money, and the provider agrees to treat and wait.
The arrangement keeps treatment going and creates the medical record the claim depends on, but it comes with obligations and risks that are sharper in North Carolina than in most states. Joshua E. Palmer, Attorney at Law uses letters of protection carefully and explains the terms to every client before one is signed. This page covers what an LOP is, how it interacts with North Carolina’s lien and evidence rules, what it looks like in a real claim, and when it is and is not the right tool.
A letter of protection is an agreement among three parties. The provider agrees to treat the patient and defer payment. The patient agrees that the bill will be paid from the recovery and remains personally responsible if the recovery does not cover it. The attorney agrees to honor the provider’s bill from the settlement funds before disbursing to the client. The provider is not paid by any insurer during treatment; it carries the account until the case ends.
LOPs are common with chiropractors, physical therapists, orthopedic and pain-management practices, and imaging centers that regularly treat injury patients. Hospitals and emergency departments rarely need one because North Carolina’s lien statute already protects them, but some will accept an LOP to pause collections.
Two North Carolina rules shape every LOP. The first is the medical lien statute. Under N.C. Gen. Stat. § 44-49, providers of medical services and supplies have a lien on a personal injury recovery, but the lien is valid only if the provider furnishes an itemized statement, records, and written notice of the lien without charge within 60 days of the attorney’s request. N.C. Gen. Stat. § 44-50 then caps all provider liens combined at 50% of the recovery, exclusive of attorney fees, so that the injured person is never left with nothing. An LOP works alongside that statute: the letter is the contract, the statute is the backstop and the ceiling.
The second rule is evidence. N.C. R. Evid. 414 limits proof of past medical expenses to amounts actually paid and, for bills not yet paid, the amounts actually necessary to satisfy them. LOP bills are by definition unpaid, so the relevant figure is what it will actually take to satisfy the provider, and the rule does not require the injured person to chase discounts the provider never agreed to. Adjusters know LOP treatment is unpaid and often argue that the charges are inflated or that the treatment was lawyer-directed rather than medically necessary, so the provider’s records must show the medical basis for every visit.
| Letter of protection | Health insurance | MedPay | |
|---|---|---|---|
| Who pays during treatment | No one; the provider waits | The health plan, at negotiated rates | Your own auto insurer, up to the limit |
| Requires proof of fault | No, but repayment depends on the claim succeeding | No | No |
| What comes out of the settlement | The provider’s bill, subject to the § 44-50 50% cap | Depends on the plan type; many fully insured plans have no recovery right | Depends on the policy and North Carolina regulation |
| Evidence value under N.C. R. Evid. 414 | Amount actually necessary to satisfy the bill | Amount actually paid | Amount actually paid |
| If the claim fails | You still owe the provider | Nothing further owed beyond deductibles and copays | Nothing further owed |
General comparison. Terms vary by provider, plan, and policy; confirm with an attorney before signing an LOP.
An illustrative example: a warehouse worker in Fayetteville, hurt in a rear-end crash on his commute, has no health insurance and a policy without MedPay. His attorney sends a letter of protection to an orthopedic practice, which treats his back injury over six months and bills $14,000. The claim later settles for $75,000. Under the LOP, the practice is paid from the settlement before the client receives his share, and if that bill and any other provider liens together exceeded 50% of the recovery after attorney fees, § 44-50 would cap them. The provider furnished its itemized bills and records within 60 days of the request, so its § 44-49 lien is valid as a backstop to the letter.
Now suppose the at-fault insurer proved that the worker had been following too closely and shared fault. Under North Carolina’s contributory negligence rule his claim would be barred entirely, there would be no settlement to pay from, and he would owe the $14,000 personally. All figures are hypothetical.
Because untreated injuries are undervalued injuries. Gaps in treatment are the most common reason adjusters discount a claim, and an LOP prevents the gap when no other payer exists. It also produces the records, diagnoses, and prognosis that turn a complaint of pain into provable damages. Without it, an uninsured injured person in North Carolina often stops treating, and the claim shrinks to match.
The matching risk is North Carolina’s all-or-nothing fault rule. An LOP is a bet that the claim will succeed, and contributory negligence means the claim can fail completely even when the other driver was mostly to blame. That makes the fault analysis the first step before an LOP is signed, not an afterthought. A lawyer who cannot answer the contributory negligence argument should not be building up unpaid medical bills on a client’s behalf. Learn how the numbers come together on our page on how a North Carolina injury settlement is valued.
Use one when treatment is medically necessary, no other payer is available or willing, and the fault evidence is strong enough that the claim is likely to succeed. Prefer health insurance or MedPay when they exist, because they pay now, often at lower rates, and frequently carry no recovery right against the settlement. Avoid an LOP for treatment that no independent physician would recommend, because an adjuster will attack it as lawyer-driven, and avoid signing one before a lawyer has evaluated the contributory negligence risk.
Joshua E. Palmer
Managing Partner · Joshua E. Palmer, Attorney at Law
Attorney Palmer concentrates in personal injury law and trained in North Carolina law at North Carolina Central University School of Law in Durham. This glossary explains the terms he uses with clients every day, in plain English and with the North Carolina rule that applies.
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Responsible attorney: Joshua E. Palmer, Managing Partner · 106 Moran Dr #5106, Bonaire, GA 31005 · (478) 887-3734. Attorney advertising. This page is general legal information about North Carolina law, not legal advice for your situation; contacting the firm does not create an attorney-client relationship.
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Each case is different. Any results, settlement figures, or benefit amounts described on this page depend on the specific facts of that case and do not guarantee or predict a similar outcome in yours. Statutes and benefit rates cited are current as of September 2026; confirm current law with an attorney before relying on it.