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If you are pursuing a personal injury claim, you have likely had to deal with significant physical injury. If you have health insurance, you may have been lucky enough to utilize it to cover a portion of your bills.
However, subrogation is a legal principle that can allow your health insurance company to seek reimbursement for those payments, particularly if you have recovered compensation for the injuries.
Continue reading to learn more about subrogation, protections against it, how to determine if your health insurance plan includes it, and how it may affect a personal injury claim.
To protect some victims against subrogation, Georgia has implemented what is commonly known as the Made Whole Doctrine.
This law requires that the victim receive total compensation for all economic and non-economic damages, or “made whole,” before an insurance company can seek compensation from the victim. It means that if you are unable to recover compensation that covers all costs associated with your injury, you may be protected from subrogation.
While many health insurance plans are subject to the Made Whole Doctrine, certain healthcare plans may be exempt from it. One example is Employee Retirement Income Security Act (ERISA) plans.
To determine whether your plan must abide by the Made Whole Doctrine or whether you may face subrogation without recovering the full amount, you may need to consider the following:
These cases can be incredibly complex, and determining whether your insurance company has the right to reimbursement involves interpreting the policy language.
Determining whether or not your plan allows for subrogation is typically the type of situation that benefits from a seasoned personal injury attorney in Augusta, GA, who understands this type of case and knows your rights.
In most circumstances, it would be unimaginable for insurance to request reimbursement over a valid claim. However, if you receive compensation for your injury, the insurance company may consider itself a financial victim of the accident and pursue reimbursement from a jury.
If your health insurance is managed by a standard insurance company and not a self-funded program, you are likely protected by Georgia’s Made Whole Doctrine. An Augusta personal injury lawyer might be able to help you understand your rights.
For example, if your health insurance pays $15,000 in medical bills after an accident, but your damages amount to $60,000, you are not considered to be ‘made whole’ until you receive the $45,000. If the remaining balance after the above deductions is less than the original amount, your provider may be unable to seek reimbursement from you.
Subrogation can help keep insurance premiums down by hedging the losses providers take when paying for injuries caused by negligence. However, when it is left unchecked, or if you don’t know your rights, you can end up going through the legal process, successfully winning a lawsuit, and somehow still miss out on necessary funds.
An Augusta personal injury lawyer can help you better understand how subrogation and Georgia’s Made Whole Doctrine might play a role in your accident case.
For more information, please contact our Augusta personal injury lawyers at Nicholson Revell Personal Injury Attorneys to schedule a free consultation today.
We proudly serve Augusta, GA, and its surrounding areas:
Nicholson Revell Personal Injury Attorneys
4137 Columbia Rd, Augusta, GA 30907
(706) 722-8784