Detailed Answer — What a medical lien/letter of protection is and how to find providers in North Dakota

When you are injured because of someone else’s negligence but you lack the money to pay up front for medical care, some doctors, clinics, imaging centers, physical therapists, and hospitals will agree to treat you on a lien basis. Commonly called a medical lien or a letter of protection (LOP), this is a written agreement where the provider agrees to defer billing and look to any settlement or judgment in your personal injury claim for payment.

How lien treatment typically works

• Provider agrees in writing (LOP) not to collect immediately and to accept payment from any settlement or judgment.
• You typically sign a release allowing the provider to be paid out of your recovery before you receive your share (an assignment or lien).
• If your claim is unsuccessful or you do not settle, you generally remain responsible for the medical bills unless the provider agreed to write them off.

Steps to find a provider who will accept a lien in North Dakota

1. Contact a personal injury lawyer early. Many medical providers will only sign an LOP if an attorney is handling the case. If you do not already have an attorney, contact the North Dakota State Bar referral service (https://www.ndbar.org) or search for local personal injury attorneys who can advise or provide a referral.
2. Ask the providers directly. Call emergency rooms, orthopedic clinics, pain-management doctors, chiropractic clinics, physical therapy practices, and imaging centers and ask whether they accept letters of protection or medical liens for personal injury cases.
3. Target providers who commonly take PI liens. Chiropractors, physical therapists, pain clinics, and some orthopedists and imaging centers often accept LOPs more frequently than other specialties. Hospitals and ERs vary; some will treat first and place a hospital lien or balance a collection against a settlement.
4. Use local resources and online search terms. Search engines and review sites with terms like “personal injury lien,” “letter of protection,” or “treat on lien” plus your city or county. Also ask your injury attorney for a list of providers who regularly work with PI clients.
5. Get the agreement in writing and be precise. If a provider will accept a lien, get a written letter of protection that names your attorney (if you have one), describes the case as a personal injury matter, states the provider’s understanding that payment will come from a settlement or judgment, and explains any fee structure or percentage the provider intends to seek.

What to expect from the written agreement

Make sure the LOP addresses:

• Who is the attorney and how to contact them (if you have one).
• Which bills and services are covered by the lien.
• Whether the provider will bill any health insurer first (if you have PIP, MedPay, or private insurance) and how that affects the lien.
• Whether the provider will accept a reduced amount or a lien percentage if the case settles for a limited amount.
• What happens if there is no recovery (you should be clear whether you will be personally liable).

Practical considerations and risks

• Providers’ policies vary. Some will accept LOPs only when an attorney is representing you. Some impose limits on types of care, dates of service, or total amounts.
• If you recover nothing, you often still owe the bills unless the provider agreed otherwise. Confirm this in writing.
• Liens can reduce your net recovery. A provider’s claim for payment will typically be paid before any money reaches you (less attorney fees and costs), so factor that into settlement expectations.
• Insurance companies may challenge the reasonableness of medical charges; providers sometimes negotiate down their liens during settlement discussions.

North Dakota legal resources and where to learn more

State law and rules that may affect medical liens, assignments, or payments are found in the North Dakota Century Code and court rules. For a starting point to search state law, see the North Dakota legislative website: https://www.legis.nd.gov. For help finding attorneys, contact the North Dakota Bar Association: https://www.ndbar.org.

When to hire an attorney

Hiring a personal injury attorney early increases your chances of getting lien-based treatment. Attorneys can:

• Negotiate LOPs with providers.
• Coordinate medical care to build the case.
• Resolve disputes about who pays medical bills (insurance vs. settlement).
• Help ensure providers properly document treatment and submit itemized bills needed for settlement.

Important: This article explains common practices but is not legal advice. If you need legal guidance about liens, medical bills, or a pending claim, consult a licensed attorney in North Dakota.

Helpful Hints — Quick checklist and tips

• Start with a PI lawyer: Ask them for providers who will accept a letter of protection.
• Call and ask upfront: Use the phrase “do you accept letters of protection or medical liens in personal injury cases?”
• Get any LOP in writing: Do not rely on verbal promises.
• Confirm scope: Make sure the LOP specifies which services, dates, and amounts it covers.
• Provide your attorney’s contact info: Many providers insist on an attorney’s involvement before signing an LOP.
• Keep copies: Keep copies of the LOP, itemized bills, and medical records to support any lien in settlement negotiations.
• Check provider credentials: If you doubt a provider, verify licensing through state resources or ask your lawyer to confirm.
• Ask about other payment sources: If you have short-term health insurance, MedPay, or PIP, disclose that — providers may bill insurance first and reduce their lien.
• Be realistic: Some specialties and hospitals rarely take liens; smaller clinics and certain therapists are more likely to do so.
• Plan for contingencies: Ask in writing what happens to your debt if the case does not result in a recovery.

Again, this information is educational and not legal advice. For case-specific guidance and to protect your rights in North Dakota, consult a licensed North Dakota personal injury attorney.