A letter of protection in Texas can be the difference between getting the MRI your doctor ordered and waiting months for an insurer to decide your claim. For people with no health insurance after a car accident, or with a deductible they cannot cover, it is often the only realistic way to keep treatment going.
It is also a tool with real trade-offs. The bills can be higher, the other side will look at them closely, and the debt does not simply disappear if the case goes badly.
The Calderon Law Firm explains those trade-offs before any client signs one. If you were hurt and are struggling to pay for care while your claim moves forward, a personal injury lawyer can review your options for free.
Key Points to Remember
- A letter of protection (LOP) delays payment for medical care until the injury case resolves; it does not erase the debt.
- Providers treating under an LOP often bill their full listed rates, and Texas courts let the defense dig into whether those rates are reasonable.
- Personal injury protection, health insurance, and medical payments coverage are usually worth using before or alongside an LOP.
- Texas lawmakers debated limits on how LOP-related medical bills are presented to juries in 2025, and the issue may return in 2027.
What Is a Letter of Protection in Texas?
A letter of protection in Texas is a written promise, usually from your lawyer, that a doctor or clinic will be paid from your injury settlement or verdict. It lets you get treatment now without paying up front, but you generally still owe the bill.
How Does a Letter of Protection Work?
A letter of protection works by shifting when the doctor gets paid, not whether you owe the bill. The typical process looks like this:
- Your lawyer sends a letter to the provider confirming that you have an injury claim and that the provider's bill will be paid from any recovery.
- The provider treats you and keeps a running balance instead of billing you or an insurer.
- Your case settles or goes to verdict, which can take months or longer.
- Before the remaining money goes to you, the provider's balance is paid from the recovery, often after a negotiated reduction.
- If there is no recovery, the provider can usually still look to you for payment, depending on the terms you signed.
Each provider writes its own paperwork, so the details vary. Read the provider's agreement as carefully as the letter itself.
A typical letter names the patient, the date of the crash, and the claim, and it promises that the provider's bill will be protected from the recovery. It usually does not set the price of treatment. That comes from the provider's own billing policies, which is why asking about prices early matters.
In simplified form, the key promise might read: "This office will protect your charges for treatment related to the March 3 crash and will pay your balance from any settlement or judgment in this matter." Rates, collection terms, and what happens if the case is lost may appear in the LOP, the provider's financial agreement, or both, so read both documents before signing.
When Does a Letter of Protection Make Sense?
A letter of protection makes sense when you need treatment that you cannot get any other way while your claim is pending. It is a bridge, not a first choice.
No Health Insurance After a Car Accident
Plenty of people work jobs without health benefits, and an emergency room visit is often the only care they receive after a crash. An LOP can open the door to follow-up care, such as orthopedic visits, physical therapy, imaging, and injections, that would otherwise be out of reach.
In Houston, that describes a lot of people working in construction, landscaping, restaurants, and delivery. Harris County residents who qualify may also get reduced-cost care through Harris Health's Financial Assistance Program, which is worth checking before or alongside an LOP.
When Insurance Will Not Cover the Care You Need
Some people have insurance with a deductible so high it might as well not exist. Others have plans that deny certain treatment or require long waits for approval. In those situations, an LOP can keep you moving while the coverage problem is sorted out.
When Doctors Will Not Take Injury Patients
José Calderón has pointed out a problem many injured people do not expect: a lot of treating physicians avoid injury patients altogether because they do not want to give depositions or spend time in court.
Providers who accept LOPs usually expect that their records may be reviewed and that they may need to explain their findings. That willingness matters when a claim depends on medical proof.
When an LOP Is Probably Not the Right Fit
An LOP is usually a poor fit when other coverage can pay for the care, when the injuries are minor and expected to heal quickly, or when there are serious questions about who caused the crash. In those situations, the extra cost and the risk of owing the full balance can outweigh the benefit.
What Are the Risks of Treating Under a Letter of Protection?
The main risk of treating under a letter of protection is that you may end up owing more, and keeping less, than you expected. Common trade-offs include:
- Higher bills. LOP providers often charge their full listed rates rather than the discounted rates insurers pay.
- Closer scrutiny. Defense lawyers frequently argue that LOP bills are inflated and that the treatment was driven by the lawsuit.
- A smaller net recovery. Every dollar paid to a provider comes out of the same settlement you receive.
- Debt if the case fails. In most agreements, you still owe the balance if the claim does not succeed.
- Third-party buyers. Some providers sell their LOP accounts to outside companies, which may be less flexible about reductions.
None of these risks means an LOP is a bad idea. They mean the decision should be made with clear eyes and with someone tracking the numbers as treatment goes on.
How Texas Courts Look at LOP Medical Bills
Texas law limits recovery of medical expenses to the amount actually paid or incurred, under Section 41.0105 of the Civil Practice and Remedies Code.
The Supreme Court of Texas applied that rule in Haygood v. De Escabedo (2011), holding that only amounts actually paid or incurred by or for the injured person can be recovered or shown to the jury. When there is no insurer discount, the question becomes whether the provider's full charge is reasonable.
In a 2021 decision, In re K & L Auto Crushers, the Supreme Court of Texas held that a defendant could seek information about what LOP providers accept from insurers and public programs, because that information is relevant to whether their charges are reasonable. Since then, the rates behind LOP bills have become a regular battleground.
| Payment arrangement or repayment claim | What usually counts as the medical expense | What it means for your claim |
| Health insurance | Amounts actually paid or still legally owed for reasonable, necessary accident-related care; contractual write-offs are excluded | Bills are lower, but the insurer may seek repayment from the settlement |
| Personal injury protection | The amount paid under your auto policy | Fast payment, limited by your PIP amount |
| Letter of protection | The provider's charge, if shown to be reasonable | Higher bills that the defense will challenge |
| Hospital lien | A statutory claim against certain recoveries, not a method of paying for treatment | Its validity and amount must be checked under Texas Property Code Chapter 55; it does not automatically equal the recoverable medical damages |
What the Defense Looks For
When LOP bills are part of a claim, defense lawyers usually look for the same weak spots.
They compare the provider's charges with what insurers pay for the same service, ask whether the lawyer referred the patient to the doctor, and look for gaps in treatment or care that does not match the injuries. Solid medical records, consistent treatment, and providers who can explain their charges are the strongest answer to those attacks.
Proving the Bills
Medical bills are often proven with sworn affidavits from providers under Section 18.001, and the defense can respond with its own counteraffidavit. When that happens, the reasonableness of an LOP bill may need testimony from the provider or another qualified witness.
In In re Allstate Indemnity Co. (2021), the Supreme Court of Texas held that a trial court went too far in striking a defense counteraffidavit and explained that an unchallenged affidavit does not end the debate over reasonableness. For LOP patients, that means the bills should be supported by records that explain why each charge makes sense.
What Are the Other Ways to Pay for Treatment?
Before relying on an LOP, it is worth checking every other source that can pay sooner and cheaper. The most common include:
- Personal injury protection (PIP), which Texas auto policies must include unless rejected in writing under Section 1952.152 of the Insurance Code
- Medical payments coverage, an optional coverage some drivers add to their auto policy
- Health insurance, even with a deductible, which often brings lower negotiated rates
- Medicare or Medicaid, which have their own billing and repayment rules that affect whether a provider can treat under an LOP
- The at-fault driver's insurer, which sometimes pays specific bills before final settlement, although this is uncommon
Hospitals that admit you within 72 hours of an accident may also have a hospital lien on your claim, which works differently from an LOP but also comes out of the recovery. Rideshare crashes add another layer, and our guide on who pays rideshare medical bills explains how Uber and Lyft coverage fits in.
What to Ask Before You Sign a Letter of Protection
Asking a few direct questions before treatment starts can prevent unpleasant surprises at settlement. José Calderón puts the goal simply: "I don't want surprises later."
Before signing, ask the provider and your lawyer:
- What will each visit, test, or procedure cost at your full rate?
- Will you send me a running balance as treatment goes on?
- Are you willing to reduce the bill if the settlement is smaller than expected?
- Will you keep the account yourself, or could it be sold to another company?
- What do I owe if the case does not result in a recovery?
Get the answers in writing when you can, and keep copies of every agreement you sign.
Could Texas Change the Rules on Letters of Protection?
The rules could change. In 2025, the Texas Legislature considered Senate Bill 30, which in its various versions would have changed how medical expenses are proven and required disclosure of referral relationships between lawyers and health care providers. The House and Senate did not agree on a final version, and the bill died at the end of the session.
What Did the 2025 Proposals Try to Change?
Different versions of the bill included ideas such as:
- Tying the evidence of medical expenses more closely to what insurers or government programs pay
- Requiring disclosure of letters of protection and of referral relationships between lawyers and providers
- Changing how affidavits and counteraffidavits on medical bills work
The Legislature returns in January 2027, and similar proposals may come back. These proposals have strong supporters in the business and insurance community and strong opponents among patient advocates and trial lawyers, so the outcome is hard to predict. Anyone treating under an LOP now should know the evidence rules could look different by the time some cases reach trial.
How a Letter of Protection Affects Settlement Timing
An LOP can affect when a case settles, because the full value of the claim is not clear until treatment is complete or the doctor can predict future care. Settling too early can leave you with bills that exceed the recovery.
An LOP does not by itself pause the deadline to file a lawsuit. Many Texas personal-injury claims have a two-year limitations period, but exceptions and other deadlines may apply. Treatment and negotiations should continue alongside a timely review of the filing deadline.
Our article on how long car accident settlements take covers the other factors that shape the timeline. In LOP cases, a lawyer also needs time at the end to negotiate provider balances so more of the settlement reaches you.
How Can You Keep Track of the Balance?
Ask each provider for an updated balance every month or two, and share it with your lawyer. Watching the total grow in real time helps everyone make better decisions about further treatment, about settlement offers, and about when to ask a provider for a reduction.
Texas Letter of Protection FAQs From Our Houston Personal Injury Attorneys
These are questions clients often ask once they are treating under an LOP.
Can I change doctors while treating under a letter of protection?
A patient treating under a letter of protection can usually change doctors, but each new provider needs its own agreement, and the earlier balances stay in place. Frequent switching can also give the defense an argument that the treatment was not medically driven, so talk with your lawyer before making a change.
Will the jury find out I treated under an LOP?
A jury often does learn about an LOP. Many Texas courts allow the defense to show that a treating doctor provided care under a letter of protection, on the theory that the doctor has a financial stake in the outcome. The judge decides how much of that the jury hears, which is one more reason consistent records matter.
Does a letter of protection show up on my credit report?
An LOP does not promise that the provider will suspend collection activity or that an unpaid bill cannot affect your credit. Before signing, ask the provider to state in writing when payment is due, whether collection is paused while the case is pending, and what happens if there is no recovery.
Do I need a lawyer to get a letter of protection?
Most providers in Texas want the letter to come from an attorney, because it confirms that a real claim exists and that someone will handle payment from the recovery. Some providers offer their own lien agreements directly to patients, but those often come with fewer protections.
Is my lawyer obligated to pay the provider from the settlement?
A Texas lawyer who signs a letter of protection is generally obligated to pay the provider from the settlement, because Texas ethics rules on handling client funds treat the provider as someone with an interest in that money. If you dispute the bill, the amount in question usually stays in the lawyer's trust account until the disagreement is worked out.
Talk With Us Before You Sign
A letter of protection can get you the care you need, but it should be part of a plan, not a guess. Knowing the costs, the alternatives, and the likely value of your case helps you decide with confidence. If you have already signed an LOP, bring a copy along with the names of every provider you have seen, and we will help you understand where things stand.
The Calderon Law Firm reviews injury cases at no cost, in English or Spanish. Call +1 (346) 999-5673 or reach us through our contact page, and learn how our personal injury lawyers handle medical bills from the first call to the final check.