NC Injury Claims and “Letters of Protection”

If you’re injured in an accident in North Carolina, your health insurance is your front line of defense against medical expenses. Just because the injuries came about as the result of an accident and someone else might be on the hook for your damages DOES NOT take your health plan off the hook for what they should be paying.

Sometimes, though, you run into problems. One of those problems is just not having health insurance. Another of those problems is finding a health care provider who thinks they should not bill your health insurance simply because of the existence of a liability claim.

In the former situation, where you just don’t have health insurance, you’re in a pickle; you need health care but you don’t have a way to pay for it easily up front. In that case, going to a provider that will treat you on a lien basis makes sense. See the link for a more thorough explanation of what that is, but essentially it’s a deal where they treat you on the hope that they’ll get paid from your potential settlement proceeds. That’s totally fine (and frankly the norm with chiropractors).

In the latter situation, where you either have health insurance and the provider (very often Wake Med or some fancy PT office) just won’t bill it, the health care provider might ask your attorney for what they might call a Letter of Protection (LOP). I cannot and will not do that. To me, an LOP creates a conflict of interest for me, where I’ve promised to hold someone else’s interest above those of my clients. See the NC Rules of Ethics for why that’s bad. I particularly don’t like this idea when its obvious that the provider is just looking for a better payday on the belief that they will get paid more from a settlement than they would. To me, this is a violation of the provider’s contract with the health plan which probably states that they HAVE to bill the health plan (but be stuck with the plan’s “adjustments” which is another word for “discount”). It’s all very sketchy in my opinion. If they don’t want to take your health insurance you should talk to your health insurance about whether the provider has that sort of option, or even better, you should just seek a more reasonably provider.

This stuff gets complicated. Call someone with experience. Call someone you can trust. Call me at 919-929-2992.

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Contact Jeffrey

Jeffrey Allen Howard, Attorney at Law, PLLC
1829 E. Franklin St. - Bldg 600
Chapel Hill, NC 27514

(P) 919-929-2992
(F) 919-636-4779

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