Letters of Protection in Georgia Personal Injury Cases

A Letter of Protection lets an injured person obtain medical treatment now and defer payment until a personal injury claim resolves. For a Georgia claimant who has no health insurance, or who needs a specialist outside an insurance network, that arrangement can be the practical bridge to care. It is not free money, and it does not make a medical bill contingent on winning. Georgia’s 2025 tort reform statute, SB 68, also changed how these arrangements are scrutinized at trial, so the way a Letter of Protection works today differs from how it worked before April 21, 2025.

What a Letter of Protection Is

A Letter of Protection, often abbreviated LOP, is a written agreement between a claimant’s attorney and a medical provider. The attorney represents that the patient was injured in an accident, that an injury claim is being pursued, and that the provider’s charges will be paid out of any settlement or judgment. In exchange, the provider treats the patient on credit and waits for payment until the case ends.

The structure is a three-way arrangement. The patient receives care, the provider defers billing, and the attorney commits to satisfying the provider’s bill from the case proceeds. The key feature is what happens if there is no recovery. An LOP defers payment; it does not extinguish the debt. If a claim fails or produces too little to cover the obligation, the unpaid balance remains the patient’s personal responsibility, and the provider may pursue collection.

Where Letters of Protection Are Used

LOPs address a recurring problem: an injured person needs treatment but cannot finance it while a claim is pending. They commonly appear when a claimant has no health insurance, when a health plan does not cover a particular specialist or procedure, when the needed provider is out of network, or when benefits have been exhausted. In practice they are most often seen with chiropractic care, orthopedic surgery, physical therapy, pain management injections, diagnostic imaging, and specialist consultations.

Acceptance is uneven across provider types. Hospitals generally decline LOPs and prefer payment upfront or through insurance billing, though hospital-based physicians such as radiologists or emergency physicians sometimes accept them. Many chiropractic and physical therapy practices that work regularly with injury patients accept LOPs as a matter of course. Orthopedic surgeons and imaging centers vary by practice, and some condition acceptance on the apparent strength of the underlying liability case.

The Risks an LOP Creates

The most misunderstood feature is that an LOP is a deferral, not a contingency. A Georgia claimant whose case produces no recovery still owes the bill. A claim can produce no recovery for several reasons, including a denied claim, a defense verdict, or a finding under Georgia’s modified comparative negligence rule that the claimant was 50% or more at fault, which bars recovery entirely under O.C.G.A. § 51-12-33. That 50% threshold is the line in Georgia; a claimant found exactly half at fault recovers nothing, a point addressed more fully in the discussion of Georgia’s comparative negligence rule.

A second risk is billed-rate inflation. Some providers who treat under LOPs bill at full chargemaster rates, higher than the negotiated rate a health insurer would pay for the same service, because payment is expected from litigation proceeds rather than an insurance contract. Before SB 68, that gap mattered less, because the full billed figure was what the jury saw as medical specials. After SB 68, the gap is exposed and challengeable.

A third risk is that multiple LOPs can outrun the recovery. When several providers each treat under an LOP, the combined obligations accumulate, and a settlement net of attorney fees and case expenses may not cover them all. When that happens, the providers and the claimant negotiate over who absorbs the reduction, and that negotiation can be contentious.

Illustration: when a settlement does not cover the LOPs

The following figures are illustrative only and do not represent any actual case or predicted outcome. Suppose three providers treat a claimant under LOPs totaling $60,000. A hypothetical settlement of $75,000, reduced by a one-third attorney fee of $25,000 and $5,000 in case expenses, leaves $45,000. That $45,000 does not cover $60,000 in LOP obligations, so $15,000 must be resolved through reductions. The arithmetic shows why providers and claimants negotiate reductions at the end of a case, not why any particular number is owed.

How SB 68 Changed the Picture

SB 68 took effect April 21, 2025. Two of its features bear directly on Letters of Protection, and both apply to causes of action arising on or after that date, meaning accidents on or after April 21, 2025.

First, the new O.C.G.A. § 51-12-1.1 framework makes LOP arrangements discoverable and admissible. A defendant can obtain the LOP agreement, the itemized charges and billing codes, information about any portion of the account receivable that was sold to a third-party medical funding company, and the identity of anyone who referred the patient to the provider. Before this change, the financial structure behind the treatment was largely invisible to the defense; now it is on the table.

Second, because O.C.G.A. § 51-12-1.1 directs the factfinder to the reasonable value of necessary care, and makes the amounts actually paid or accepted admissible alongside billed charges, LOP billing at full chargemaster rates is open to attack. A defense can argue that the reasonable value of a service is closer to what insurers actually pay than to the billed LOP figure. The practical effect can invert the old incentive: under the prior rule, a higher billed figure meant a higher specials number for the jury, while under the new rule a higher billed figure that the defense shows to be inflated can erode credibility.

How an LOP Compares to Using Health Insurance

Where a claimant has health insurance that covers the needed care, using it generally produces a documented, negotiated payment that establishes a defensible reasonable-value figure under the SB 68 framework. LOP treatment generally produces a chargemaster-rate bill that the defense may attack as inflated. The comparison is not always available, however. When a health plan does not cover the necessary treatment, an LOP can remain the only practical route to care, and the medical necessity of that treatment does not disappear because of a strategic disadvantage at trial. How medical specials are valued under the reasonable-value framework is examined in the discussion of SB 68 and medical damages, and how LOP obligations interact with medical liens at distribution is addressed in the discussion of medical liens in Georgia settlements.

Frequently Asked Questions

Does a Letter of Protection guarantee the medical bill will be paid?
No. It commits the claimant’s attorney to pay the provider from any recovery, but if there is no recovery, or the recovery is insufficient, the balance remains the patient’s debt. An LOP defers payment; it does not make the bill contingent on the case succeeding.

Are Letters of Protection admissible in a Georgia trial now?
For causes of action arising on or after April 21, 2025, O.C.G.A. § 51-12-1.1 makes LOP arrangements and the associated billing information discoverable and admissible. A jury may consider that information when determining the reasonable value of care.

Can a defendant question whether LOP charges are inflated?
Under the SB 68 reasonable-value framework, a defendant may introduce evidence of the amounts actually paid or accepted for comparable care and argue that the reasonable value is lower than the billed LOP figure. Whether that argument succeeds depends on the evidence in a particular case.

Does using an LOP affect a claimant’s credit?
It can. If a case does not resolve in time or produces no recovery, an unpaid LOP balance can be sent to collections like any other medical debt, which may affect credit. The arrangement does not insulate the patient from that outcome.

Sources and Legal Authorities

• O.C.G.A. § 51-12-1.1 (reasonable value of medical care; amounts paid or accepted admissible; Letters of Protection discoverable and admissible; SB 68, causes of action arising on or after April 21, 2025).
• O.C.G.A. § 51-12-33 (Georgia modified comparative negligence; recovery barred at 50% or more fault).
• Senate Bill 68 (Georgia 2025 tort reform), effective April 21, 2025.

Disclaimer

This guide is general legal information about Georgia law and is not legal advice. It is not provided by a law firm and creates no attorney-client relationship. Statutes and their interpretation change over time, and how the law applies depends on the specific facts of a situation. Anyone facing a specific question about a Letter of Protection or an injury claim should consult a licensed Georgia attorney.