If you work in personal injury — whether as an attorney, a chiropractor, or both — you’ve encountered Letters of Protection. But they’re one of the most misunderstood documents in the PI ecosystem. This guide explains exactly what an LOP is, how it works in practice, what makes one enforceable, and what both attorneys and treating providers need to know to use them effectively.
A Letter of Protection (LOP) is a written agreement between a personal injury attorney and a healthcare provider — in this context, a chiropractic clinic — that allows a patient to receive treatment without paying upfront, with the provider’s fees to be paid directly from the proceeds of a future settlement or judgment.
In plain English: the attorney guarantees the chiropractor will get paid when the case settles, in exchange for the chiropractor agreeing to treat the patient on credit until that point.
LOPs exist because most personal injury patients can’t afford to pay for ongoing chiropractic care out of pocket after an accident, and health insurance often either doesn’t cover accident-related treatment or creates subrogation complications. The LOP bridges this gap.
The process flows like this:
Not all LOPs are created equal. A poorly drafted LOP can leave a chiropractor unpaid even after a settlement. A well-drafted LOP protects both parties. At minimum, an LOP should contain:
Full legal name of the attorney and law firm, the patient (client), and the chiropractic clinic. The LOP is a contract — all parties must be clearly identified.
A brief description of the injury event: date, type of accident, and the parties involved. This ties the LOP to a specific claim.
The clinic’s agreement to treat the patient and defer payment until settlement, in exchange for the attorney’s guarantee.
The attorney’s binding commitment to: (a) notify the provider of any settlement or judgment, (b) pay the provider’s bill from settlement proceeds before disbursing funds to the client, and (c) not settle the case without accounting for the provider’s outstanding balance.
Some LOPs include a cap on the amount covered. If the treatment exceeds the cap, the excess is either the patient’s responsibility or must be renegotiated. Both parties should understand this clearly.
In most PI cases, the treating provider agrees to negotiate their bill if the settlement is insufficient to cover all liens at full value. The language here matters — “will reduce at attorney’s request” is very different from “will reduce to X% of the billed amount.”
The LOP must be signed by the attorney, the clinic’s authorized representative, and ideally the patient acknowledging their understanding of the arrangement.
Treating without a countersigned LOP. If the patient’s case resolves and there’s no signed LOP in place, you have limited legal recourse. Never begin PI treatment on an unsigned LOP.
Vague or unenforceable language. An LOP that says only “we will pay your bills from the settlement” without specifying the attorney’s obligations gives you little protection if a dispute arises.
No notification clause. Without a clause requiring the attorney to notify you before disbursing settlement funds, the attorney could pay the client and leave your bill as a collection problem.
Caps that don’t match your treatment plan. If a patient needs 6 months of treatment but the LOP only covers $3,000, you’ll reach the cap quickly. Discuss realistic treatment duration with the attorney upfront.
Over-reliance on verbal assurances. “We always take care of our providers” is not an LOP. Get it in writing, every time.
Not verifying the provider’s LOP process. If you refer to a clinic that doesn’t have a proper LOP tracking system, you’ll be managing their billing questions during settlement negotiations — which is exactly the kind of friction that slows case resolution.
Sending to providers with inflated billing. The treating provider’s bill is part of your case economics. A $30,000 chiropractic bill on a $40,000 liability policy leaves almost nothing for your client after your fee. Establish billing expectations upfront.
Signing LOPs without reviewing fee schedules. Know what you’re committing to. Some clinics charge at 150–200% of Medicare rates; others are more conservative. The difference directly affects net recovery.
Not maintaining an LOP ledger. Track every outstanding LOP by case so you know your total lien exposure at any point during settlement negotiations.
This is the most common concern for chiropractors considering PI work. If a case doesn’t settle and no judgment is awarded:
The practical reality: most PI cases resolve. If you are working with reputable attorneys on cases with clear liability, the “no recovery” scenario is relatively rare. But it happens, and you should have a policy for it.
| Factor | LOP | Health Insurance |
|---|---|---|
| Payment timing | At settlement (months to years) | 30–60 days post-claim |
| Rate | Negotiated (typically higher) | Contracted fee schedule |
| Documentation burden | High — PI-level notes required | Standard clinical documentation |
| Collection risk | Moderate — depends on case outcome | Low — insurer bears collection risk |
| Relationship value | High — builds attorney partnerships | Low — no ongoing relationship benefit |
For clinics with strong documentation systems and an established attorney network, LOPs typically generate higher revenue per case than equivalent health insurance billing. The tradeoff is delayed payment and higher documentation standards.
Whether you’re an attorney managing LOP relationships or a chiropractor accepting PI patients, these practices reduce friction and protect both parties:
A well-executed LOP process benefits everyone: the patient gets care they couldn’t otherwise afford, the chiropractor gets a higher-value patient without upfront collection risk, and the attorney gets a documented treatment record that strengthens the case.
AttorneyChiro includes built-in LOP tracking, automated follow-ups, and a collaborative billing dashboard for attorneys and clinics. See how it works.
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