Ambulance Services – Liens and Garnishment



IMPORTANT: This article assumes that you have read the Liens and Subrogation Overview or that you have a firm understanding of how subrogation relates to personal injury claims and settlements.

North Carolina law protects medical providers by providing them with the limited statutory right to secure an interest in the proceeds from an individual’s personal injury settlement or judgment, commonly known as or referred to as a “medical lien.”

These medicals liens are generally referred to as Medical Provider, Physicians, or 44-49 liens (please visit the following link for more information on N.C.G.S. §44-49 liens). Ambulance services (EMS) are also provided with the same lien rights and are included in North Carolina Gen. Stat. 44-49.

As such, if you are taken by ambulance to a medical facility following an accident, the ambulance service (EMS) may have a right to reimbursement (lien) from certain funds that you recover from your accident.

EMS services are unique, however, because unlike other medical providers, under the law an EMS provider may also file a lien against real property per North Carolina Gen. Stat. § 44-51.1. In other words, if you have used an ambulance service operated by a county or municipal agency, and you fail to pay for the services, the EMS provider may attach a lien to your home or any land you own. Essentially, this means that when you sell your home or property, portions of the sale proceeds must go to the EMS provider in order to pay the lien amount. The lien exists for a maximum of ten (10) years after the date that the ambulance service was provided, generally the date of the accident.

Furthermore, in order for the lien to be valid against your real property, the EMS provider must file within the statutory guidelines of the county. Depending on the county, the lien must be filed within 90 days from the date of service or filed within a window of time, which is generally after 90 days from the date of service and before 180 days from the date of service. The lien must be filed in the Office of the Clerk of Superior Court. Failure to properly file the lien will result in the lien being invalid and unenforceable.

**Important Note: Failure to file within the allotted time only invalidates the real property lien. The EMS provider will still have other recourse to seek reimbursement for unpaid bills, such as a 44-49 lien, mentioned above.

More importantly, ambulance services provided by or funded by a county or municipal agency may garnish wages and income, per North Carolina Gen. Stat. § 44-51.4. In other words, if you fail to pay your ambulance bill, the EMS provider may take a portion of your wages each month in order to pay off the bill amount. These types of liens are effective because as long as you have income, the EMS provider will receive some amount of reimbursement each month.

The key point to take away from this article is that ambulance providers have multiple means available to ensure that they are reimbursed for services provided. Understanding the different avenues an EMS provider can take to ensure payment may help prevent harsh outcomes such as garnishment of your wages.


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