A settlement figure is a headline, not a payment. The number in the release is the gross, the amount the insurer wires to the attorney's trust account, and almost none of it moves directly to the client. Between that wire and the check there is a disbursement statement, usually one page, listing the fee, the case costs, and every party who has claimed a right to be paid out of the recovery. Reading that page slowly, before signing it, is the last real chance to change the outcome. Here is what sits on it, in the order it is typically deducted.
1. The contingency fee, calculated on gross
Take a $100,000 settlement and a one-third fee agreement. The fee is $33,333, and in most agreements it is computed on the gross figure, before costs and before any lien is paid, which matters because a fee on the net would be smaller. Some agreements step the percentage up if a lawsuit is filed or a case is set for trial, commonly to 40 percent, so the timing of settlement changes the arithmetic. A careful reader checks which base the agreement names, gross or net, and whether the step-up has already been triggered by the filing of a complaint.
2. Case costs, which are separate from the fee
Costs are the money advanced to build the file: certified medical records, the filing fee, a court reporter, postage, a records retrieval service, sometimes a treating physician's narrative report. In this example they total $2,150, and they come off after the fee, leaving $64,517 to satisfy everyone else. Costs are rarely negotiable after the fact, but they are itemizable, and a reader who asks for the backup receipts will get them. What deserves attention is any line labeled as a general administrative charge rather than a specific expense.
3. The hospital lien filed on the emergency visit
Most states let a hospital record a lien against a personal injury recovery for the unpaid portion of its charges, often within a set number of days after discharge. Here the hospital asserted $18,400 in billed charges from the emergency department and two days of observation. Billed charges are not the same as the amount a payer would have accepted, and hospital liens are routinely negotiated down, particularly where the total recovery is limited by a policy cap. In this case the lien resolved at $11,000, a reduction of just over 40 percent.
4. Health plan subrogation and government recovery
If a health insurer paid for treatment caused by someone else, its plan document almost certainly gives it a right to be reimbursed from the settlement. A self-funded employer plan governed by federal law may have stronger reimbursement terms than a state-regulated policy, so the first question is which type of plan paid. This plan claimed $9,600 and accepted $6,400 after a common fund reduction reflecting the attorney's work in creating the recovery. Where Medicare or Medicaid paid, the Centers for Medicare and Medicaid Services oversees recovery of those conditional payments, and the reduction for procurement costs follows a fixed formula rather than a negotiation.
5. Unpaid provider balances and the number at the bottom
The last category is treatment nobody insured: the chiropractor seen on a letter of protection, the imaging center that never got paid, the copays that went to collections. Here that came to $2,300, paid in full because the provider had a signed agreement and no incentive to discount. Adding the three obligations gives $19,700, and $64,517 less $19,700 is a net check of $44,817, or roughly 45 percent of the headline figure. That ratio is ordinary, not a sign that something went wrong, and knowing it in advance is what makes an offer easy to evaluate.
What to verify before the disbursement is signed
Ask for the lien letters themselves rather than a summary, because the amount a provider first demands and the amount it will accept are different numbers, and the file should show both. Confirm that every claimed lien covers treatment for this injury and not an unrelated condition billed in the same period. Check whether any balance was already written off or paid by insurance, since duplicate claims appear more often than people expect. Then confirm the fee percentage matches the signed agreement. Those four checks take an afternoon and regularly move the net figure by thousands.