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If you’ve ever had medical bills covered by your health insurance after an accident, you might be surprised to learn that your insurer can ask for that money back. This is known as subrogation, and it often comes up when you receive a settlement from the at-fault party. Knowing how it works can help you plan ahead and avoid unexpected financial surprises.
At The Stoddard Firm, we guide Atlanta residents to be aware of what is subrogation in health insurance.
Subrogation in health insurance means that if someone else was responsible for your injuries, your health insurance company has the right to be paid back for the medical bills they covered.
For example, if another driver causes a car accident and your health insurance pays for your hospital stay, your insurer can later request reimbursement from the at-fault driver’s insurance once you receive a settlement.
Insurance companies use subrogation to recover costs and keep overall premiums lower for everyone. Without it, they’d be paying out medical expenses even when someone else was clearly at fault.
Subrogation also helps:
When an insurance company pays your medical bills, they assume temporary responsibility for your costs. However, subrogation allows the companies to transfer this responsibility back to the liable party. This ensures that the insurer doesn’t bear undue financial burdens for injuries caused by someone else’s negligence.
Subrogation applies when your health insurance covers medical costs after an accident that wasn’t your fault. Your insurer then has the right to seek repayment if you receive a settlement or court award.
The subrogation typically applies in the following ways:
Imagine you are injured in a car accident caused by another driver. Your health insurance covers $20,000 in medical expenses while you recover. Later, you file a personal injury claim and receive a $50,000 settlement from the at-fault driver’s insurer. Through subrogation, your health insurance company requests repayment of the $20,000 they covered, as long as they are not paying for another party’s liability. This principle is reinforced by Georgia law, which states that an insurer may only seek subrogation when the insured has been “fully and completely compensated” for their losses.
When you receive a settlement or court award for a personal injury case, it’s natural to assume that the money is yours to cover lost wages, medical costs, pain and suffering, and other damages. However, if your health insurance company covered your medical bills after the accident, they may have a legal right to claim a portion of your settlement through subrogation.
This means that before you see the full payout, your insurer could step in to recover the expenses they paid on your behalf. The amount they can claim depends on several factors, including the terms of your health insurance policy, state laws, and whether your attorney negotiates a reduction in the repayment amount.
In Georgia, subrogation rights in workers’ compensation cases are governed by OCGA § 34-9-11.1(b), which allows for a subrogation lien on settlement monies, but only if the injured party has been fully compensated.
Once your health insurance covers your medical bills, they keep track of your claim. If you pursue a personal injury settlement, they’ll assert their subrogation rights and request reimbursement.
However, this isn’t always set in stone. Your attorney can negotiate with your insurer to reduce their claim, ensuring you keep a fair share of your settlement. Legal doctrines like the “Made Whole Doctrine“ or the “Common Fund Doctrine“ can sometimes limit how much your insurer can recover. Managing this process carefully can help protect your financial interests.
In a personal injury case, medical expenses may be covered by:
Determining who ultimately pays for medical bills in a personal injury case depends on many factors, including the type of insurance coverage available and the liability of the parties involved. If the injured person has health insurance, their insurer may cover initial medical costs but later pursue reimbursement through subrogation.
Subrogation can significantly impact the amount you ultimately receive from a personal injury settlement. If your health insurance company asserts a subrogation claim, a portion of your settlement will be allocated to reimburse them for the medical expenses they covered. This can reduce the funds available to you for other damages, such as pain and suffering or lost wages.
However, an attorney can help negotiate a reduction in the subrogation claim, making sure you retain as much of your settlement as possible. By carefully looking up the subrogation process, you can protect your financial interests and maximize your final compensation.
Here’s what could happen if subrogation isn’t addressed properly:
Handling subrogation effectively starts with understanding your insurance policy. Reviewing the terms can clarify how much your insurer can claim and whether you have room to negotiate. If your insurance company asserts a claim, working with a lawyer can often lead to a reduced repayment amount—helping you keep more of your settlement.
Following subrogation in health insurance and negotiations can be challenging. At The Stoddard Firm, we help with personal injury cases in Atlanta to protect their settlements and minimize insurer claims. Contact us today for a consultation to guarantee you receive the full compensation you deserve.
A dedicated, ethical advocate who takes on major corporations and global insurers with virtually unlimited resources. Known for high-profile cases featured on Courtroom Viewing Network, this attorney is also a sought-after legal educator, teaching at seminars for top bar associations. Trusted by clients and media alike, they work tirelessly to secure justice and deliver results.
Member of the Atlanta Bar Association, the Georgia Bar Association, and the Georgia Trial Lawyers Association
Licensed in Georgia since: 2008
Education: University of Georgia School of Law
Personal injury compensation enables an injured individual to regain the same quality of life they had before the incident. This may entail funds for modifying a home for wheelchair accessibility or offering vocational training for those unable to return to their previous job. It is crucial for compensation to cover lost earnings and cover both past and anticipated medical costs.
We conduct interviews with colleagues, consult with attending healthcare professionals, and engage specialists to ensure we secure comprehensive compensation that aids our clients in re-establishing their life trajectories.
When deciding to hire an Atlanta personal injury lawyer, you need to consider:
1. Who’s at Fault
If you’re in an accident and it’s unclear who’s responsible, seeking advice from an attorney is wise. Insurance companies may attempt to attribute damages to you in such scenarios. An attorney can shield you from counterclaims and cross-claims, safeguarding your rights.
2. The Severity of Injuries Sustained
When facing a lifetime of pain, suffering, and mounting bills, taking chances is not an option. A personal injury attorney is entrusted with averting lifelong financial strain.
3. If You’re Facing Insurance Company Denial or Delay
The intricate laws and procedures surrounding personal injury claims are areas where insurance companies capitalize on individuals’ lack of expertise. A lawyer can provide invaluable assistance in this regard.
It’s possible but not necessarily probable and will likely depend on whether you want your case to go to trial. The majority of cases end in a settlement. Going to trial typically occurs when there are intricate, contentious matters regarding the accident’s cause or the severity of your injuries. Occasionally, defendants may simply be unyielding and unwilling to settle or you may just want more than the insurer believes is reasonable.
It shouldn’t be a shock if your attorney diligently pursues a settlement while also readying your witnesses for trial. A proficient lawyer must be equipped for any scenario. Demonstrating to the opposing party that we’re gearing up for a trial indicates that we’re resolute and not inclined to back down.
Determining all potential parties who could be held liable for a personal injury involves a thorough investigation of various factors. If someone else neglected to exercise reasonable care, they can be held accountable for the resulting injuries, as outlined in Title 51 of Georgia Code of Laws or as outlined in Georgia’s common law.
The individual directly involved in the accident may not be the sole party at fault. For instance, in the case of a drunk driving accident, while the driver may bear responsibility, the person who knowingly provided additional alcohol to an obviously intoxicated individual could also be deemed liable. In other circumstances, an at fault party’s employer is responsible for its employees actions.
Following a personal injury accident, there are critical steps you should take. First and foremost, seek prompt medical attention. Visit the emergency room or call for an ambulance at the accident site. Any delay in receiving medical care could impact your health and the outcome of your personal injury case.
Refrain from discussing your case with the insurance company representing the at-fault party. They may deny your settlement or offer a significantly lower amount than you deserve.
Additionally, it’s crucial for both you and your personal injury attorney to gather as much evidence and documentation as possible. This is vital in establishing that your injuries resulted from someone else’s negligence. Make an effort to collect records and documents related to your case, including medical records, police reports, photographs, witness contact information, and similar items. Once you’ve received medical attention, contact The Stoddard Firm.
Do not say anything! If an insurance company contacts you, refrain from providing any information until you have consulted with your attorney. Insurance companies typically contact accident victims in an attempt to elicit a statement about the incident, which they may use to devalue the settlement.
While you may eventually need to converse with them, seeking guidance from a seasoned legal team is crucial. They will provide clear instructions on what you should and should not disclose to protect the value of your case.
If you or a loved one has been injured due to someone else’s negligence, we’re here to help. Fill out the form below, and one of our experienced Atlanta personal injury attorneys will contact you shortly to discuss your case. Call us 678-RESULTS.
Your information will remain confidential and used solely to contact you about your case.
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I went through one of the worst times of my life. When I decided to reach out to Matt it was one of the best decisions I have ever made. He really is a genuine guy who cares about his clients. He worked hard for me and my family for 2 years until we were awarded a settlement we felt deserving! I could not recommend a better guy for your legal services!
Attorney Matthew Stoddard and his staff are awesome professionals. I contacted them with a problem, in my opinion he went above and beyond to assist me. He showed understanding and care and exceeded my expectations.
The Stoddard Firm did an excellent job in representing me in my case ! They went far and beyond to help me, even driving 4 hours to meet me multiple times as a client!!! I honestly felt like I was a member of their legal team and would recommend them to anyone in need of a great lawyer!!!
This page has been written, edited, and reviewed by a team of legal writers following our comprehensive editorial guidelines. This page was revised and approved by Attorney Matthew B. Stoddard, who has more than 16 years of legal experience as a personal injury attorney.
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If you or a loved one has been injured due to someone else’s negligence, we’re here to help. Fill out the form below, and one of our experienced Atlanta personal injury attorneys will contact you shortly to discuss your case. Call us 678-RESULTS.
Your information will remain confidential and used solely to contact you about your case.
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