ERISA Subrogation Settlement Small Pot
ERISA subrogation settlement small pot is not a national pay-order. 29 U.S.C. § 1144 states that ERISA shall supersede state laws that relate to an employee benefit plan. 29 U.S.C. § 1132 lists civil actions to recover benefits due under the terms of his plan. Competing G.S. 44-50 and 42 C.F.R. § 411.37 list separate rules on the same pot.
Last updated: September 9, 2026
ERISA subrogation settlement small pot
29 U.S.C. § 1144 / § 1132 / § 1002 and 42 C.F.R. § 411.37 / 42 U.S.C. § 1395y are federal law. North Carolina hospital-lien, Medicaid, and State Health Plan rows are North Carolina law — and G.S. 135-48.37 is State Health Plan law.
| Claim | Listed | Source |
|---|---|---|
| NC hospital/provider lien on PI recoveries | “there is hereby created a lien upon any sums recovered as damages for personal injury in any civil action in this State” | G.S. 44-49 |
| Lien favors physician/dentist/nurse/hospital | “services rendered by any physician, dentist, nurse, or hospital” | G.S. 44-49 |
| Perfection: itemized statement within 60 days of attorney request | “within 60 days of receipt of the request, an itemized statement, hospital record, or medical report” | G.S. 44-49 |
| Lien attaches to settlement funds | “A lien as provided under G.S. 44-49 shall also attach upon all funds paid to any person in compensation for or settlement of the injuries, whether in litigation or otherwise” | G.S. 44-50 |
| Attorney's fees not interfered with | “Nothing in this section or in G.S. 44-49 shall be construed so as to interfere with any amount due for attorney's services” | G.S. 44-50 |
| Provider lien cap 50% exclusive of attorneys' fees | “The lien provided for shall in no case, exclusive of attorneys' fees, exceed fifty percent (50%) of the amount of damages recovered” | G.S. 44-50 |
| ERISA preemption | “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan” | 29 U.S.C. § 1144 |
| Insurance savings clause (fully insured fork) | “nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities” | 29 U.S.C. § 1144 |
| Deemer clause (plan not deemed insurer) | “shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company” | 29 U.S.C. § 1144 |
| Civil action to recover benefits under plan terms | “to recover benefits due to him under the terms of his plan” | 29 U.S.C. § 1132 |
| Civil action to enforce rights under plan terms | “to enforce his rights under the terms of the plan” | 29 U.S.C. § 1132 |
| Persons empowered to bring a civil action | “A civil action may be brought” | 29 U.S.C. § 1132 |
| Employee welfare benefit plan covers medical/hospital benefits | “medical, surgical, or hospital care or benefits” | 29 U.S.C. § 1002 |
| Medicare procurement-cost reduction | “Medicare reduces its recovery to take account of the cost of procuring the judgment or settlement, as provided in this section, if—” | 42 C.F.R. § 411.37 |
| 411.37 disputed-claim condition | “Procurement costs are incurred because the claim is disputed” | 42 C.F.R. § 411.37 |
| NC Medicaid one-third presumption | “If the amount of the Medicaid claim does not exceed one-third of the medical assistance beneficiary's gross recovery, it is presumed that the gross recovery includes compensation for the full amount of the Medicaid claim” | G.S. 108A-57 |
| NC SHP right to first recovery (SHP only — not private ERISA) | “The Plan has the right to first recovery on any amounts so recovered, whether by the Plan or the Plan member” | G.S. 135-48.37 |
| NC SHP lien cap 50% (SHP only) | “In no event shall the Plan's lien exceed fifty percent (50%) of the total damages recovered by the Plan member” | G.S. 135-48.37 |
| NC SHP statutory subrogation right (SHP only) | “The Plan shall have the right of subrogation upon all of the Plan member” | G.S. 135-48.37 |
| Medicare conditional payment conditioned on Trust Fund reimbursement | “Any such payment by the Secretary shall be conditioned on reimbursement to the appropriate Trust Fund” | 42 U.S.C. § 1395y |
Sources fetched September 9, 2026: 29 U.S.C. § 1144, 29 U.S.C. § 1132, 29 U.S.C. § 1002, G.S. 44-49, G.S. 44-50, 42 C.F.R. § 411.37, 42 U.S.C. § 1395y, G.S. 108A-57, G.S. 135-48.37.
Plan terms and preemption — what the law says
29 U.S.C. § 1144 states that ERISA shall supersede state laws that relate to an employee benefit plan, saves state insurance regulation, and states that a plan shall not be deemed an insurance company. 29 U.S.C. § 1132 lists civil actions to recover benefits due under the terms of his plan and to enforce rights under the terms of the plan. 29 U.S.C. § 1002 states that an employee welfare benefit plan may provide medical, surgical, or hospital care or benefits. Those provisions point to plan terms and preemption forks.
Competing published methods on the same pot
G.S. 44-50 states that a G.S. 44-49 lien attaches to settlement funds, does not interfere with attorney's services, and shall in no case, exclusive of attorneys' fees, exceed fifty percent (50%) of damages recovered. 42 C.F.R. § 411.37 lists Medicare's procurement-cost reduction when the claim is disputed. G.S. 108A-57 lists a one-third Medicaid presumption. G.S. 135-48.37 lists State Health Plan first-recovery language. Those are competing published methods.
What is ERISA Subrogation Settlement Small Pot?
ERISA subrogation settlement small pot describes when an ERISA plan reimbursement claim under 29 U.S.C. § 1144 and plan terms under 29 U.S.C. § 1132 competes with other published claims on a limited third-party recovery — including North Carolina G.S. 44-50 hospital liens and 42 C.F.R. § 411.37 Medicare procurement-cost reduction.
What plan-terms language does 29 U.S.C. § 1132 list?
29 U.S.C. § 1132 states that a civil action may be brought to recover benefits due to him under the terms of his plan and to enforce his rights under the terms of the plan. Those provisions point to plan terms.
What competing claims are listed beside an ERISA plan on a small pot?
North Carolina G.S. 44-50 states that a G.S. 44-49 lien attaches to settlement funds, does not interfere with attorney's services, and shall in no case, exclusive of attorneys' fees, exceed fifty percent (50%) of damages recovered. 42 C.F.R. § 411.37 states that Medicare reduces its recovery to take account of procurement costs when the claim is disputed. G.S. 108A-57 lists a one-third Medicaid presumption. Those are competing published methods.
Is the North Carolina State Health Plan the same as a private ERISA plan?
No. G.S. 135-48.37 states that the Plan has the right to first recovery and that the Plan's lien shall in no event exceed fifty percent (50%) of total damages recovered by the Plan member. Those provisions are State Health Plan law.