My Health Insurance Wants Part of My Personal Injury Recovery: What is Subrogation?


April 09, 2013

While each case is different, some personal injury claims and lawsuits may take many months if not years to resolve before the victim receives compensation for his or her injuries. Typically, an accident victim’s medical expenses will be covered by his or her own health insurance company in the interim. If you don’t have health insurance, an experienced personal injury lawyer can frequently help make sure you receive the treatment you need. In many cases payment can be deferred until your case is resolved. What accident victims generally do not expect once they finally receive compensation in a personal injury settlement is that their health insurance company may file a claim to be reimbursed for the amounts they have paid for the medical costs associated with their policyholder’s injuries.

Most insurance contracts offered by Georgia health insurance companies claim a right to “reimbursement” (also known as "subrogation") in personal injury cases. Reimbursement claims are essentially a right to recoovery asserted by an insurance provider where the carrier has covered medical expenses related to injuries suffered in a personal injury accident. It is aggravating enough to be injured in a car crash, a slip and fall in the grocery store or by a dangerous or defective product only to have your health insurance carrier assert a reimbursement claim. You will have been the one that endured the pain and suffering and may have undergone long and arduous rehabilitative therapy. The insurance company really gets a windfall when you recover in a personal injury settlement because you have been paying premiums often for years so that your health insurance provider will cover medical expenses when you are injured or sick.

Despite any contractual provision in your health insurance that provides for reimbursement, Georgia OCGA § 33- 24-56.1 contains a provision that limits such contractual rights to recover from your settlement or verdict.. This Georgia statute contains the “Make Whole Doctrine,” which limits an insurance carrier’s reimbursement rights to the extent that you as a personal injury victim have not been made whole for all of your economic and non-economic damages by settlement of your personal injury claim. However, there are exceptions to this doctrine where the insurance is a self-funded Federal ERISA plan. Many employer provided health insurance plans are ERISA plans and may assert a right to reimbursement under federal law.

The applicability of a reimbursement claim or the make whole doctrine to your case will depend on the specific facts and circumstances of your situation. This is a crucial issue because a reimbursement claim can be for hundreds of thousands of dollars if you have suffered catastrophic injuries. These are funds that could improve the quality of your care and future enjoyment of life. If you have been injured in a serious Georgia auto collision or have otherwise been injured by the negligent conduct of a third-party, our dedicated and experienced Atlanta personal injury attorneys carefully investigate, protect and advise our clients regarding any potential reimbursement rights of insurance companies. We are committed to obtaining the best possible results for our clients and to providing exemplary legal services as part of our goal of developing a reputation as the best personal injury attorneys in Georgia.

Montlick and Associates is available to assist clients throughout all of Georgia and the Southeast, including but not limited to Albany, Athens, Atlanta, Augusta, Columbus, Gainesville, Macon, Marietta, Rome, Roswell, Savannah, Smyrna, Valdosta, Warner Robins and all smaller cities and rural areas in the state. No matter where you are located our attorneys are just a phone call away, and we will even come to you. Call us 24 hours a day/7 days a week for your Free Consultation at 1-800-LAW-NEED (1-800-529-6333). You can also visit us online at www.montlick.com and use our Free Case Evaluation Form or 24-hour Live Online Chat.

Category: Auto Accidents

Please Note:
Many of our blog articles discuss the law. All information provided about the law is very general in nature and should not be relied upon as legal advice. Every situation is different, and should be analyzed by a lawyer who can provide individualized advice based on the facts involved in your unique situation, and a consideration of all of the nuances of the statutes and case law that apply at the time.