Texas Legal Glossary · Personal Injury

Letter of Protection (LOP)

Written and reviewed by Shane M. Boasberg, founder of SMB Law, PC · Licensed in Texas since 2003 · Updated October 2026

Definition: A letter of protection is a letter from an injured person’s attorney promising a medical provider payment from the eventual settlement or judgment, so treatment can proceed in Texas without insurance or upfront payment. The patient stays responsible if the case fails.

Also called: LOP, medical lien letter

What a letter of protection means in Texas

A letter of protection, or LOP, is a written promise from a personal injury lawyer to a doctor, imaging center, or surgical facility. The lawyer agrees to protect the provider’s bill and pay it out of any settlement or judgment before the client receives money. In exchange the provider treats the patient now and waits for payment.

An LOP is not a statute and not a court order. It is a contract between the law office and the provider. The patient remains liable for the charges if the case is lost or settles for less than expected, although providers in that position often negotiate.

How it works in practice

LOPs fill the gap for people with no health insurance, high deductibles, or a health plan that balks at paying for a car crash. The provider bills at its full chargemaster rate, not a discounted insurance rate, and the bill is presented as part of the damages through a Section 18.001 affidavit under the Civil Practice and Remedies Code.

Defendants push back hard. In In re K&L Auto Crushers, LLC, 627 S.W.3d 239 (Tex. 2021), the Texas Supreme Court held that a defendant may obtain discovery of the provider’s negotiated rates with insurers and the prices it accepts from other payors, to test whether the LOP charges are reasonable. Counter-affidavits under § 18.001(f) are the usual vehicle for that challenge. Expect the defense to argue that LOP charges are inflated and that the lawyer’s referral relationship with the provider is relevant.

Why it matters in your case

Treatment on an LOP gets an uninsured person the MRI or surgery they need. It also creates a bill that must be repaid from the recovery, and that bill is a target at trial. Because the paid or incurred rule limits medical damages to amounts actually paid or still owed, an LOP bill is fully “incurred” and can be claimed in full, but only if the charges survive a reasonableness challenge. We weigh the trade-off before sending one.

Example

Priya has no health insurance when a delivery van runs a light on Burnet Road and injures her shoulder. Her lawyer sends an LOP to an orthopedic group in Round Rock, which performs arthroscopic surgery and bills $38,000. At mediation the defense produces evidence that the group accepts about a third of that from insurers. The parties settle, the orthopedic group accepts a reduced payment, and Priya nets the difference.

This entry explains Texas law in general terms and is not legal advice for any specific situation. Statutes and case law change; the date above reflects the last review.