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Medical

How a Letter of Protection Gets You Medical Care

Updated September 14, 2026

A written agreement where a personal injury attorney promises to pay a healthcare provider from the client's eventual settlement or verdict, allowing the patient to receive medical treatment without paying out of pocket.

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Understanding Letter of Protection (LOP)

A letter of protection (LOP) is a legal document sent by a personal injury attorney to a healthcare provider. It guarantees that the provider will be paid for treating the attorney's client from a future settlement or verdict. The LOP creates a medical lien — the provider's legal right to be repaid from the settlement. In practice, "LOP" and "medical lien" are often used interchangeably, but technically the LOP is the document and the lien is the legal claim it creates. LOPs are a three-party agreement involving the attorney (who guarantees payment), the medical provider (who delivers treatment and defers payment), and the patient (who receives care without upfront costs). Common provider types who treat on LOP include chiropractors, orthopedic surgeons, pain management specialists, and physical therapists.

Quilia keeps a free directory of personal injury providers, with the ones that have said they accept liens or letters of protection marked. Browse providers that accept liens, chiropractors and pain management.

Examples

  • 1Chiropractor treating a car accident victim under an LOP while the case is pending
  • 2Orthopedic surgery performed with an attorney's LOP guarantee of payment from settlement
  • 3Physical therapy provided for months pending case settlement, with bills deferred under the LOP
  • 4Medical lien company purchasing a provider's LOP-based lien at a discount for immediate cash flow

Why This Matters in Legal Cases

LOPs are the mechanism that funds medical treatment in most personal injury cases. Without them, injured patients who lack insurance or funds would go untreated — weakening both their health and their case. For providers, LOPs provide a steady stream of patients referred by PI attorneys, though they take on the risk that the case might not settle favorably. For attorneys, LOPs ensure their clients get the documented treatment that builds a stronger case. The LOP ecosystem connects attorneys, providers, and sometimes lien companies into a treatment-funding loop that makes PI litigation possible.

Frequently Asked Questions

What is a letter of protection in personal injury?

A letter of protection (LOP) is a legal document sent by a personal injury attorney to a healthcare provider, guaranteeing that the provider will be paid for treatment from a future settlement or verdict. It allows injured patients to receive medical care without paying upfront.

Who sends a letter of protection?

The personal injury attorney sends the LOP to the healthcare provider on behalf of their client. It is a three-party agreement involving the attorney (who guarantees payment), the provider (who delivers treatment), and the patient (who receives care).

Can a provider sell a lien created by an LOP?

Yes. Providers can sell their LOP-based liens to medical lien companies at a discount, typically around 20 cents on the dollar. This gives the provider immediate cash flow instead of waiting months or years for the case to settle.

Are letters of protection legally binding?

Yes. A letter of protection is a legally binding agreement. However, enforcement varies by state. Some states have specific statutes governing LOPs, while others rely on contract law. The attorney is obligated to protect the provider's lien from the settlement proceeds.

What is the difference between an LOP and a medical lien?

An LOP is the document — the written agreement between the attorney and provider. A medical lien is the legal right it creates — the provider's claim against the settlement funds. The LOP creates the lien. In practice, the terms are often used interchangeably.

Sources

Related Terms

Medical Lien

A legal claim that gives a healthcare provider the right to be repaid from a personal injury settlement or verdict for treatment they provided to an injured patient. The provider treats the patient now and gets paid later when the case resolves.

Subrogation

The right of an insurance company to pursue a third party who caused the loss to recover the amount paid on a claim.

Contingency Fee

A fee arrangement where the attorney's payment is contingent upon winning the case. The attorney receives a percentage of the recovery, typically 33-40%, and no fee if the case is lost.

Lien

A legal claim against a settlement or judgment that must be paid before the injured party receives their money, typically held by medical providers or insurers.

Settlement

An agreement between parties to resolve a legal dispute without going to trial. Settlements typically involve the defendant paying the plaintiff an agreed-upon sum in exchange for dropping the lawsuit.

Last updated: September 14, 2026
Reviewed by: Quilia Legal Content Team

Did you know?

A letter of protection is only as good as the treatment record behind it. Quilia asks the client after each appointment whether they went, who they saw and how they are feeling, and writes the answer to the case file the same day, so the bills that arrive months later have a contemporaneous record to sit against.

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