How a Letter of Protection Gets You Medical Care
Updated November 2, 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.
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.
Which Doctors and Chiropractors Treat on an LOP
Most providers who treat on a letter of protection, or "on a lien" as most offices put it, see accident patients every week: chiropractors, physical therapists, pain management clinics, orthopedists, imaging centers and surgery centers. Many primary care offices and hospital systems do not, because they bill health insurance and are not set up to wait for a settlement.
Before treating, a provider usually asks the firm for the signed letter, the date of the accident, the insurance claim details and the treatment the client needs. Many also want regular case status updates while they wait, and word before the case settles so the lien is paid from the settlement rather than chased afterward.
Whether the client owes the balance if the case does not recover enough depends on the letter's terms and state law, so tell the client what their letter says before the first visit.
To find providers near a client, browse the free Quilia directory of providers that accept liens and letters of protection, or the chiropractor listings.
Placing a client in another city? The directory lists personal injury providers in Las Vegas, Henderson, Phoenix, Scottsdale, Tucson and Houston.
For the provider side of an LOP, see the personal injury chiropractor handbook, how providers request a case status update and how Quilia keeps treatment on the case file.
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?
Which providers treat on a letter of protection?
Who sends a letter of protection?
Can a provider sell a lien created by an LOP?
Are letters of protection legally binding?
What is the difference between an LOP and a medical lien?
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.
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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