A Letter of Protection is an agreement between an attorney and a medical provider that allows an accident victim to receive treatment now and pay from a future settlement or judgment. For people without health insurance or who need specialists outside their insurance network, an LOP is often the only way to access the medical treatment their case requires. But LOPs carry risks that most patients do not fully understand, and SB 68 changed the strategic calculation significantly.
How a Letter of Protection Works
The mechanic is straightforward. A letter of protection is sent by the claimant’s legal representative to a medical provider, stating that the patient was injured in an accident, that a personal injury claim is being pursued, and that the attorney guarantees payment of the provider’s charges from any settlement or judgment obtained. The provider agrees to treat on credit, deferring payment until the case resolves.
The LOP creates a three-way arrangement: the patient receives treatment, the provider defers billing, and the attorney commits to paying the provider from the case proceeds. If the case succeeds, the provider is paid from the settlement. If the case fails or produces an insufficient settlement, the provider’s unpaid bill remains the patient’s responsibility.
When LOPs Are Used
LOPs serve a genuine need in several scenarios. The patient has no health insurance and cannot afford out-of-pocket medical care. The patient’s health insurance does not cover certain specialists or treatments the injury requires. The patient needs treatment from a provider outside their insurance network who has particular expertise in the injury type. The patient’s health insurance has been exhausted or does not cover the volume of treatment required.
In practice, LOPs are most commonly used for chiropractic treatment, orthopedic surgery, physical therapy, pain management injections, MRI and diagnostic imaging, and specialist consultations.
Which Providers Accept LOPs
Not all medical providers accept Letters of Protection, and understanding who does and who does not prevents frustration.
Hospitals: Generally do not accept LOPs. Hospitals want payment upfront or through insurance billing. Exception: hospital-based physicians (emergency medicine doctors, radiologists) may accept LOPs even when the hospital itself does not.
Chiropractors: The majority accept LOPs. Many chiropractic practices build their business model around personal injury patients treated under LOPs.
Orthopedic surgeons: Varies significantly by practice. Some accept LOPs for surgical procedures but require upfront payment for initial consultations. Others accept LOPs only for patients with strong liability cases.
Physical therapy: Most accept LOPs, particularly practices that work regularly with personal injury patients.
MRI and imaging centers: Mixed. Some accept LOPs, others require prepayment or insurance billing. Availability varies by market.
Pain management: Varies by practice and procedure.
The Risks LOPs Create for Patients
You Owe the Bill If the Case Fails
An LOP does not make your medical bill contingent on winning the case. It defers payment. If your case produces no recovery (the claim is denied, you are found more than 50% at fault, or the settlement is insufficient to cover all obligations), the medical provider’s bill remains your personal debt. The provider may send the unpaid balance to collections, and it can affect your credit.
This risk is not always communicated to patients at the time they agree to treatment under an LOP. Before agreeing to LOP treatment, understanding that you are personally liable for the charges if the case does not produce enough money to pay them is essential.
LOP Billing May Be Inflated
Some providers who treat patients under LOPs bill at chargemaster rates or above, higher than they would bill an insurance company, because the payment is expected to come from litigation proceeds rather than an insurance contract with negotiated rates. A $15,000 MRI bill under an LOP may represent the same imaging that a health insurer would pay $2,500 for.
Before SB 68, this inflation was less consequential because the full billed amount was presented to the jury as the medical damages figure. After SB 68, inflated LOP billing is now visible and challengeable.
Settlement May Not Cover All LOPs
When multiple providers treat you under LOPs, the total LOP obligations can accumulate quickly. Three providers, each billing $10,000 to $20,000, create $30,000 to $60,000 in LOP obligations. If the settlement is $75,000 and the attorney fee is $25,000 and case expenses are $5,000, the remaining $45,000 may not cover $60,000 in LOP obligations. Someone does not get paid in full, and the negotiation over who takes the reduction can be contentious.
How SB 68 Changed the LOP Landscape
SB 68 made two changes that directly affect Letters of Protection for accidents occurring on or after April 21, 2025.
LOPs Are Now Discoverable
Under the new O.C.G.A. § 51-12-1.1, LOP arrangements are discoverable and admissible in litigation. The defendant can obtain the LOP agreement itself, the itemized charges with specific billing codes, the name and dollar amount of any portion of the account receivable sold to a third party (some LOP accounts are sold to medical funding companies), and the identity of anyone who referred the patient to the provider for treatment.
The transparency this creates is significant. Before SB 68, the LOP arrangement was invisible to the defense. After SB 68, the defense can see the entire financial structure behind the treatment, including whether the charges appear inflated relative to insurance-negotiated rates for the same procedures.
LOP Charges Face “Reasonable Value” Scrutiny
Because SB 68 allows juries to consider the amount “actually necessary to satisfy” medical charges, LOP billing at chargemaster rates is now vulnerable to challenge. The defense can argue that the “reasonable value” of a $15,000 MRI is closer to the $2,500 that insurance companies pay for the same imaging, and that the LOP charge reflects litigation-driven inflation rather than the actual value of the service.
This changes the strategic calculation for LOPs. Under the old rule, higher LOP charges produced higher medical damages figures for the jury. Under the new rule, higher LOP charges may produce lower credibility with the jury if the defense effectively demonstrates the inflation.
LOP vs. Health Insurance: A Strategic Comparison
If you have health insurance, using it for accident-related treatment rather than relying on LOPs is now generally the stronger strategic choice under SB 68. Health insurance produces a documented, contractually negotiated payment that establishes a defensible floor for the reasonable value of treatment. LOP treatment produces a chargemaster-rate bill that the defense can attack as inflated.
The exception: when health insurance does not cover the treatment you need (out-of-network specialist, exhausted benefits, treatment type not covered by your plan), LOPs remain the practical path to accessing care. The strategic disadvantage of LOP billing under SB 68 does not eliminate the medical necessity of treatment that only an LOP can finance.
For how medical damages are calculated under SB 68’s reasonable value framework, see How SB 68 Changed Medical Damage Calculations in Georgia. For how medical liens and LOP obligations interact during settlement distribution, see Medical Liens in Georgia Car Accident Settlements.
This guide covers Letters of Protection in Georgia personal injury cases as of March 2026. SB 68 (April 2025) made LOP arrangements discoverable and admissible under O.C.G.A. § 51-12-1.1 for causes of action arising on or after April 21, 2025. Laws change. This information is educational and does not constitute legal advice. If you need advice about your specific situation, consult a licensed Georgia attorney.
Last updated: March 2026
