Hospital Lien vs ERISA Plan Priority
Hospital lien vs ERISA plan priority is not a national ranking. North Carolina G.S. 44-50 states that a G.S. 44-49 lien attaches to settlement funds and shall not exceed fifty percent (50%) of damages exclusive of attorneys' fees. 29 U.S.C. § 1144 lists ERISA preemption and the deemer rule, not an automatic wipe of a perfected hospital lien.
Last updated: September 8, 2026
Hospital lien vs ERISA plan priority
North Carolina hospital-lien and State Health Plan rows are North Carolina law. 29 U.S.C. § 1144 and 42 C.F.R. § 411.37 are federal law.
| Claim | Listed | Source |
|---|---|---|
| NC hospital/provider lien on personal-injury 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, or hospital for injury-related care | “services rendered by any physician, dentist, nurse, or hospital, or hospital attention or services rendered in connection with the injury” | G.S. 44-49 |
| Perfection needs 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 |
| NC State Health Plan lien superior to nongovernmental liens (not private ERISA) | “The priority of a lien held by the State Health Plan for Teachers and State Employees shall be superior to all nongovernmental liens and rights” | G.S. 44-49 |
| Lien also 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 by 44-49/44-50 | “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 fifty percent (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 of state laws that relate to employee benefit plans | “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 an insurance company | “shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company” | 29 U.S.C. § 1144 |
| NC State Health Plan right to first recovery | “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 fifty percent (50%) of total damages recovered | “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 Medicaid one-third small-pot 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” | G.S. 108A-57 |
| Medicare reduces recovery for procurement costs when claim disputed | “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 procurement-cost condition | “Procurement costs are incurred because the claim is disputed” | 42 C.F.R. § 411.37 |
Sources fetched September 8, 2026: G.S. 44-49, G.S. 44-50, 29 U.S.C. § 1144, G.S. 135-48.37, G.S. 108A-57, 42 C.F.R. § 411.37.
What funding status does and does not do
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. That self-funded versus fully insured fork can change which state limits bind the plan. It does not provide an automatic wipe of a perfected hospital lien.
Separate published methods on the same pot
G.S. 44-50 lists attorney-fee non-interference and the fifty percent (50%) provider-lien cap. 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 Hospital Lien vs ERISA Plan Priority?
Hospital lien vs ERISA plan priority compares a state hospital statutory lien (North Carolina G.S. 44-49 and G.S. 44-50 list creation, settlement attachment, attorney-fee non-interference, and a fifty percent (50%) provider-lien cap exclusive of attorneys' fees) with an ERISA plan reimbursement claim under 29 U.S.C. § 1144 (preemption, insurance savings, and deemer).
Does self-funded status automatically put the plan ahead of a hospital lien?
No. 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. That fork does not provide an automatic wipe of a perfected hospital lien.
What does North Carolina list for hospital liens on settlements?
G.S. 44-49 creates a lien upon sums recovered as damages for personal injury for physician, dentist, nurse, or hospital services connected with the injury, and lists perfection timing for an itemized statement. G.S. 44-50 states that the lien also 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.
Is the North Carolina State Health Plan the same as a private ERISA plan?
No. G.S. 135-48.37 lists a State Health Plan 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. G.S. 44-49 separately states that a State Health Plan lien is superior to nongovernmental liens. Those provisions are State Health Plan law.
How do Medicare and Medicaid claims sit beside hospital-versus-plan ranking?
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 presumption for North Carolina Medicaid on the beneficiary's gross recovery. Those are separate published methods on the same pot.