Letter of protection rides for injury cases: attorney rules, liens, and getting paid at settlement

Some riders call after a car crash or a fall with a lawyer on their side and no insurance that pays for rides. A letter of protection (LOP) is how many of those rides get booked: the rider’s lawyer puts in writing that your bill will be paid out of the settlement or verdict, and you agree to wait for your money. Before you accept one, know what the lawyer can legally promise, what happens if the case loses, and which records keep your balance intact when the check finally arrives. If the rider’s own auto policy pays for rides, bill that first. Billing auto insurance for medical transportation covers PIP and no-fault claims.

What a letter of protection promises

An LOP is a promise to pay from the proceeds of a case, not a promise to pay no matter what. Florida’s injury damages statute describes the arrangement well: a provider renders treatment “in exchange for a promise of payment for the claimant’s medical expenses from any judgment or settlement,” and the label applies whatever the paper is called (Fla. Stat. 768.0427(1)(d)).

Three parties sign up for different things:

• The rider owes you for the rides. The letter changes when you get paid. It does not erase the rider’s debt unless you agree to that in writing.
• The lawyer agrees to pay your bill from the money that passes through the firm’s trust account when the case resolves.
• Your company agrees to hold off on collecting until then.

Rides for injury cases run like any other private-pay work on the road. The difference is the wait, which can be long, and the risk that the case produces less than the bills.

Can the lawyer guarantee the bill?

Generally no. Most states’ professional conduct rules include a version of Rule 1.8(e), which bars a lawyer from giving a client financial assistance in connection with a lawsuit, apart from court costs and litigation expenses. Tennessee’s Board of Professional Responsibility spelled out what that means for medical bills in Formal Ethics Opinion 2010-F-154, dated September 10, 2010. Because a lawyer cannot pay or advance a client’s medical expenses before or during litigation, the lawyer cannot agree to guarantee them or accept ultimate liability for them either. The board adopted Arizona Opinion 03-05, which reached the same answer.

So when a case is lost or dropped, there is nothing in the trust account to pay you from. When it settles for less than the bills, the shortfall is not the lawyer’s to cover. Either way, the rider is your only debtor for what is left. Two steps follow from that:

1. Have the rider sign, alongside the letter, a promise to pay any balance the case does not cover.
2. Set a limit on how many rides you will carry on credit for one rider before you need a payment or a written update from the firm.

Which rides a lawyer may pay for directly

Rule 1.8(e) lets lawyers advance litigation expenses but not living or medical costs, and state bar committees place rides on different sides of that line:

• New York. In Opinion 1044, issued in January 2015, the state bar’s ethics committee said a lawyer may advance a client’s taxi fare to an independent medical examination under no-fault, because attending the exam is a condition of receiving benefits. Rides to treating doctors qualify when they are needed to diagnose or demonstrate the client’s condition, or the client’s efforts to treat it, for the case. The committee expected many such rides to qualify but said some routine care would not. Repayment can depend on the outcome, and for an indigent or pro bono client the lawyer may pay without repayment.
• Connecticut. Informal Opinion 2020-03, dated November 18, 2020, approved a public defender buying an indigent client a bus or train ticket to court. The same opinion repeats Connecticut’s earlier view that transportation so a personal injury client can get medical treatment falls outside the exceptions, and that the state’s rule has no general humanitarian exception.
• The narrow newer exception. The Connecticut opinion notes that New York amended its rule on June 18, 2020, and that the ABA amended its model rule, to allow limited help for indigent clients from lawyers working pro bono or for nonprofit legal services. Neither change covers a paying personal injury client.

In practice, ask the firm which rides it will pay as case expenses, such as trips to an insurer’s medical exam, a deposition, or a doctor who will testify. Invoice those to the firm on their own terms, and bill everything else to the LOP account.

When the lawyer must hold money for you

A signed letter of protection turns your bill from a debt the client owes into money the lawyer must protect. Under Rule 1.15, a lawyer holding settlement money that a third person has a valid claim to must either pay that person or keep the disputed amount safe until the dispute is resolved. Tennessee’s 2010 opinion lists the interests that trigger that duty. “A letter of protection or similar obligation specifically entered into to aid in obtaining the funds” is on the list, along with signed assignments, perfected liens, judgments, and court orders.

The same opinion adopts an Arizona analysis of twelve situations, and providers should read it closely. The lawyer had to protect the provider’s share when:

• The client or the lawyer had signed a letter of protection or an assignment.
• The lawyer had agreed, even orally, to pay the provider from the settlement.
• The client had signed a lien in the provider’s favor, recorded or not.

The lawyer owed the provider nothing when it had only sent bills or a demand letter, or when the lawyer merely knew the provider had treated the client. Invoices sent to a law firm without a signed agreement leave you an unsecured creditor.

Do not assume a lien statute covers you instead. Read who your state’s statute names. New York’s, Lien Law 189, gives a lien only to hospitals run by charitable corporations, the State University of New York, or local governments, for patients who received emergency treatment or were admitted within a week of the injury. A wheelchair van company is not on that list. In New York, its protection is the contract.

Florida’s disclosure rules for LOP medical bills

Florida changed how medical bills under letters of protection are proven in 2023, in chapter 2023-15, now section 768.0427. To claim medical expenses for treatment under an LOP, the injured person must disclose:

1. A copy of the letter of protection.
2. Itemized bills, coded with CPT or HCPCS codes in effect on the date of service.
3. The name of any factoring company that bought the account, and what it paid.
4. Whether the person had health coverage when treated, and with whom.
5. Whether the lawyer referred the person for treatment, and who made the referral.

A referral by the claimant’s lawyer is admissible, and the financial relationship between the firm and the provider, including the number and frequency of referrals, is relevant to the provider’s bias as a witness. For people without coverage, or with Medicare or Medicaid, the statute also admits 120 percent of the Medicare rate as evidence of unpaid charges, or 170 percent of the state Medicaid rate where Medicare has no rate.

The section defines health care provider by license type. Its list borrows the providers licensed by Florida’s Agency for Health Care Administration (Fla. Stat. 408.802), such as hospitals, nursing homes, and home health agencies, plus practitioners, pharmacies, and a few others. Transportation companies are not named. Whether these rules reach a ride company’s bill turns on that definition, so ask the rider’s lawyer how your charges will be presented. Coding each ride with a HCPCS code such as A0130 for a wheelchair van trip costs nothing and answers the question if it comes up.

When another payer should go first

An LOP should carry only the rides no one else will pay for. Check these first:

• The rider’s auto policy. In no-fault states, the rider’s own insurer may pay for rides to treatment. New York’s no-fault coverage, for example, pays rides to treatment as an “other reasonable and necessary expense,” up to $25 a day for one year from the accident (Insurance Law 5102(a)(3)). The auto insurance billing guide covers each state’s rules.
• Workers’ compensation. If the injury happened on the job, rides are part of the medical benefit and need the insurer’s approval. See workers’ comp transportation.
• Medicaid. A Medicaid rider’s covered trips are booked by the state’s broker or health plan. When the state learns of a liable third party after paying, federal rules require it to seek reimbursement within 60 days after the end of that month (42 CFR 433.139(d)). Never bill a lawyer for a trip Medicaid already paid for. The third-party liability entry explains how states pursue it.

Paperwork that holds up when the check arrives

Collect these before you run the first ride, and update them as the case goes on:

1. The letter itself, signed by the rider and the lawyer, naming your company, the rider, the case, and the accident date.
2. Your rate sheet, attached and initialed.
3. The rider’s own promise to pay any balance the case does not cover.
4. A consent letting you share ride records with the named firm.
5. A trip record for every ride: date, pickup and drop-off addresses and times, the appointment it served, miles, and the rider’s signature.
6. A monthly statement to the firm with the running balance. It keeps your claim in front of the lawyer and dates your notice.
7. Proof of every notice you send, including a copy of the letter to any new firm if the rider changes lawyers.

A worked example

Example: a rider hurt in a crash needs a wheelchair van to physical therapy three times a week for 12 weeks. At an example rate of $90 per round trip, that is 36 round trips and $3,240 carried on the rider’s account. If the case settles and the firm asks you to accept two thirds, you would collect $2,160 and write off $1,080. Decide before that call what reduction, if any, you will accept and how fast you need the money. If the case loses, the $3,240 is a private-pay balance owed by the rider alone, which is why the rider’s signed promise matters more than the lawyer’s letter.

Tracking LOP rides in HealthRide

HealthRide records each ride’s GPS-recorded miles, pickup and drop-off times, and the rider’s signature in the driver app, and the trip log exports to CSV or PDF for the law firm. Cash, checks, facility invoices, broker payments and insurance payments go in the same list, matched to trips and invoices, so a balance that sits for months is still easy to total. See reports and payments.