What is a Letter of Protection in a Texas Injury Case?

You were hurt in an accident someone else caused, the medical bills keep coming, and your case against the at-fault driver or property owner could take months to resolve. If you don’t have health insurance, or your plan won’t cover treatment tied to the accident, paying for an MRI or a course of physical therapy out of pocket isn’t realistic. A letter of protection is one way injured Texans get the care they need now and handle the bill from the recovery at the end.

Letter of Protection Basics

A letter of protection, also called an LOP, is a written agreement between three people: you as the injured patient, your personal injury attorney, and the doctor or facility treating you. Your attorney sends the letter, usually on firm letterhead, and promises the provider will be paid from any settlement or court award you receive. In return, the provider treats you without payment up front and waits for payment from the case instead of billing you or sending the account to collections while the case is open.

Your attorney handles the money at the end. Whatever you owe comes out of your recovery before you receive your share, and you stay responsible for any amount the recovery doesn’t cover.

Who a Letter of Protection Helps in Texas

A letter of protection fits a specific situation: you need treatment for your injuries but have no clear way to pay for it while the case is pending. You might need one if:

• You have no health insurance, so nothing covers treatment for the accident.
• Your health plan denies the bills and points to the at-fault party’s insurance company as the one that should pay.
• Your out-of-pocket costs, a high deductible or large copays, put the care you need out of reach right now.
• A specialist your doctor refers you to, an orthopedic surgeon or a neurologist, wants payment arranged before treating you.

Whether a letter is right for you depends on your case and your coverage, and your attorney decides after weighing whether the case can support repayment.

A Letter of Protection and Your Recoverable Medical Bills

Texas Civil Practice and Remedies Code § 41.0105 limits your recovery of medical expenses to the amount paid or incurred on your behalf, which is what a provider is entitled to collect for your care. Running your injury bills through health insurance can shrink your recovery, because your health plan pays the provider a discounted rate, and the discounted figure becomes the most you can recover from the at-fault party, so the discount benefits the party who injured you.

A letter of protection keeps the provider’s full charge as the recoverable amount, so your attorney may handle your accident care through a letter to protect the value of your medical bills. Preserving the full charge does not guarantee you recover the full amount, since the at-fault party can still challenge the charge as unreasonable. Your attorney weighs the odds of a challenge against the coverage you already have and decides which combination of a letter and your health insurance serves you best.

A Letter of Protection and Settling Under Pressure

An injury case can take months to settle, and your treatment and living costs keep coming while the case runs. With bills due and no income coming in, the insurance company’s first offer gets tempting, even a low one.

A letter of protection covers your treatment in the meantime, so paying the bills doesn’t depend on settling. You can turn down an offer that falls short and wait for a full resolution, because your care is handled either way.

Trade-Offs to Weigh Before You Sign

A letter of protection solves the timing problem with your medical bills, and it carries trade-offs you should weigh before signing.

• You still owe the bill. If the recovery doesn’t cover the full amount, the gap is yours to pay, though your attorney works to bring the balances down first.
• Your provider options narrow. Not every doctor or hospital accepts a letter of protection, so you choose from the ones that do.
• A provider has reason to overtreat. With payment tied to your case instead of a health plan’s rates, the incentive runs toward more treatment and higher charges, which lowers what you keep.
• Your take-home shrinks. Every dollar paid to a provider out of the recovery is a dollar that doesn’t reach you.
• Defense lawyers can challenge the charges. They regularly argue that letter-of-protection bills run higher than what’s reasonable, so a steady treatment record, with no long gaps between visits, helps the bills hold their value when the recovery is worked out.

A letter of protection can still be the right call, which is why the decision belongs in a conversation with an attorney who can look at your case and your treatment needs together.

A Letter of Protection vs. a Medical Lien

A letter of protection and a hospital lien both end with a provider paid from your recovery, but they work differently. What separates the two is consent: you decide whether to sign a letter of protection, while a hospital lien attaches whether you agree or not, and your attorney works to reduce or clear the lien after it is filed.

Texas Property Code § 55.002 gives a hospital a lien on your case and any settlement or judgment when it treats you for accident injuries and you were admitted within 72 hours of the accident. A hospital secures the lien by recording written notice with the county clerk before any money is paid out, and you never sign anything. The lien reaches only the recovery from the at-fault party, so your own health insurance and your home stay outside it. Under § 55.004, a hospital lien cannot take more than half of what you recover.

Texas Billing Rules That Affect a Letter of Protection

Texas Civil Practice and Remedies Code § 146.002 requires a health care provider to bill you by the first day of the eleventh month after the date of service. A case under a letter of protection can take longer than that to resolve, which once created a problem for providers who agreed to wait.

House Bill 4145 took effect September 1, 2025. When an attorney represents you, the provider now meets the billing deadline by sending the bill to your attorney, which is where the statements go under a letter of protection anyway. Your provider can wait for the case to resolve without giving up the right to collect.

A Sample Letter of Protection

A letter of protection usually runs about a page and follows a standard format. Below is a generic example of the parts a Texas attorney’s letter generally includes. Your attorney drafts the letter around the facts of your case, so use the example as an illustration rather than a form to send on your own.

[Date]

[Provider or facility name, street address, city, state, ZIP]

Re: Letter of Protection for [client name], date of accident [date]

Dear [provider name],

I represent [client name] for injuries from an accident on [date]. [Client name] needs medical treatment but cannot pay up front while the case is pending.

I am asking your office to treat [client name] under this letter of protection. In place of payment at the time of service, I agree that your reasonable and necessary charges will be paid from any settlement or judgment in the case, before the funds are released to [client name]. [Client name] stays responsible for the balance, and the letter defers payment rather than canceling it. Please send billing statements and records to my office, and hold collection activity while the case is open.

Please sign below to confirm your agreement and return a copy to my office.

Sincerely,

[Attorney name], [law firm name], [phone, email]

Agreed and accepted: __________________________ [provider signature] / [date]

Your Cost to Set Up a Letter of Protection

Setting up a letter of protection costs you nothing up front. You don’t pay your attorney or the provider to put one in place, and a personal injury firm on a contingency fee only collects if you recover. What the provider charges comes out of your settlement or award at the end, so you pay nothing along the way.

Talk with Loewy Law Firm About Your Case

Loewy Law Firm represents injured people across Austin and throughout Texas. Connecting clients with doctors who treat under a letter of protection is part of the representation, so you can get into care while your case is pending. If accident bills are coming in and you’re holding off on treatment because of the cost, reach out to Loewy Law Firm at (512) 280-0800 for a free consultation to talk through whether a letter of protection fits your situation.