Understanding letters of protection in Texas PI cases

A Letter of Protection (LOP) is a written agreement between your attorney, your medical provider, and you. It says the provider will treat you now without asking for payment up front, and in exchange the attorney agrees to pay the medical bill directly out of your settlement when the case resolves.

For personal injury patients in Texas, LOPs solve a real problem. Health insurance often refuses to cover crash-related care, MedPay caps out quickly, and the at-fault driver's insurance won't pay a dime until the case settles — which can take a year or more. Without an LOP, patients either skip care they need or drain savings paying out of pocket.

How it works in practice: your attorney sends the LOP to the clinic before your first visit. The clinic treats you the same as any other patient — evaluation, adjustments, rehab, imaging if needed. Billing accrues on the LOP instead of going through insurance. When your case settles, the attorney pays the clinic from the settlement funds before disbursing the balance to you.

What to ask your attorney: Does the provider accept LOPs on a reduction basis? (Meaning: will they reduce the bill if the settlement is smaller than expected.) Is the LOP a lien against just this settlement, or against future claims too? What happens if the case doesn't settle?

That last question matters. Most LOPs specify that if the case is lost or the plaintiff walks away, the patient becomes personally responsible for the bill. Reputable clinics — ours included — will work with patients in those situations, but the language should be spelled out before you sign.

Reduction Letters vs LOPs: A reduction letter is a separate agreement, usually signed at the end of the case, where the provider agrees to accept less than the full billed amount so the patient nets more from the settlement. Providers who accept LOPs almost always accept reduction letters too. Providers who don't accept LOPs generally won't.

We accept both LOPs and reduction letters at all four Helix locations. If you're an attorney evaluating a new client, or a patient trying to figure out whether your case qualifies, call us and we'll walk through the specifics.