Jan182026
Wrongful Death

If I accept a settlement, how do I find out what I’ll actually take home after Medicare reimbursement and other liens are paid? – North Carolina

Short Answer

In North Carolina, the only reliable way to know what will be “take-home” from a settlement is to get a written settlement breakdown that lists the gross settlement, attorney fees and case costs, and every lien or reimbursement claim (including Medicare) that must be paid from the proceeds. Medicare reimbursement is usually based on Medicare’s “conditional payments” for accident-related care, and the final amount often cannot be confirmed until Medicare issues a final demand. North Carolina law also recognizes certain medical provider liens on injury recoveries, and the disbursing attorney generally must hold back enough money to address valid liens before distributing the rest.

Understanding the Problem

In a North Carolina injury settlement, the decision point is whether accepting the insurer’s “top and final” offer makes sense once Medicare reimbursement, medical provider liens, and attorney fees and costs are subtracted. The practical question is: after the settlement check arrives and the required paybacks are handled, what amount remains for the injured person. This issue often comes up when medical paperwork shows large “charges,” but the settlement offer feels low and there is uncertainty about what must be repaid and what can be negotiated or disputed.

Apply the Law

North Carolina law allows certain medical providers and entities that paid for accident-related care to assert reimbursement rights against an injury recovery. Separately, Medicare has federal recovery rights when it paid for treatment related to the accident. In practice, settlement funds are typically deposited into an attorney trust account, and the attorney prepares a written distribution statement showing the gross settlement, deductions (fees/costs), lien payments, and the net amount to the client. If a medical lien is claimed, North Carolina law generally requires the person handling the settlement funds to retain enough to pay valid, noticed claims before disbursing the remainder.

Key Requirements

  • Identify all reimbursement claims: Confirm whether Medicare paid anything related to the accident (conditional payments) and whether any providers/insurers/state programs are asserting liens or subrogation claims.
  • Verify the lien is valid and properly noticed: For many provider liens under North Carolina law, the lienholder must provide notice and supporting documentation to the attorney on request within a set time, or the lien may not be valid as a lien under the statute.
  • Get a written settlement accounting before final distribution: A written breakdown should show the total settlement, attorney fees and costs, each lien claimed, and what is being paid on each lien so the net amount can be calculated.

What the Statutes Say

Analysis

Apply the Rule to the Facts: The settlement offer feels low compared to the medical paperwork, but the “take-home” number depends on (1) what Medicare actually paid for accident-related treatment, (2) whether any providers or payors have valid liens or reimbursement claims, and (3) the attorney fee and case costs. With multiple providers and physical therapy, it is common for several bills to exist but only some to translate into enforceable liens, and Medicare’s final reimbursement amount may not be confirmed until a final demand is issued. A proper written distribution statement is what converts a gross offer into a realistic net figure.

Process & Timing

  1. Who requests the numbers: The injured person’s attorney (or the injured person if unrepresented). Where: Through Medicare’s recovery process and directly with providers/insurers asserting claims in North Carolina. What: A Medicare conditional payment summary and final demand (when available), plus written lien notices and itemized statements from providers; then a written settlement distribution statement from the disbursing attorney. When: As early as possible during settlement negotiations, and again immediately after a settlement is reached so the final net can be confirmed before final disbursement.
  2. Confirm and challenge where appropriate: Compare the claimed lien amounts to the accident-related treatment and the dates of service. If a provider lien is asserted under North Carolina’s lien statutes, request the required itemized statement/records and written notice; if the amount is disputed, the claim may need to be resolved before payment.
  3. Disburse and document: After the settlement funds clear, the attorney typically pays agreed liens/reimbursement claims from the trust account, deducts the agreed fee and costs, and issues the net payment along with a written breakdown showing each deduction.

Exceptions & Pitfalls

  • “Charges” are not the same as “liens”: Medical paperwork often lists full charges, but the enforceable payback may be different depending on insurance adjustments, what was actually paid, and whether a valid lien or reimbursement right exists.
  • Medicare amounts can change during the case: Medicare’s conditional payment total can increase as more bills are processed, and the final demand may differ from early estimates.
  • Multiple claimants to the same dollars: When several liens exist, North Carolina’s lien rules can require holding funds and paying valid claims in a way that fits the statute, rather than simply following informal instructions.
  • Disputes must be handled before money goes out: If a lien amount is disputed, paying it “just to be safe” can reduce the net unnecessarily; ignoring it can create problems for the disbursing party and delay distribution.

Conclusion

In North Carolina, the “take-home” amount from a settlement is the gross settlement minus attorney fees and costs and minus any valid reimbursement claims such as Medicare conditional payments and properly asserted medical liens. The dependable way to know the net is to confirm each lien in writing and then review a written settlement distribution statement showing every deduction and payment. The next step is to request a written lien and Medicare payoff update and have the disbursing attorney prepare a settlement breakdown before final disbursement.

Talk to a Wrongful Death Attorney

If a settlement offer feels too low once Medicare reimbursement and other liens are considered, our firm has experienced attorneys who can help explain the lien process, confirm what must be repaid, and estimate a realistic take-home number before funds are distributed. 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.

Category: Wrongful Death

Author: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.