Subrogation: Turning Health Insurance Companies into Lending Companies

A common and justified assumption amongst many people who have health insurance is that if they are in a car accident, or suffer any injury caused by another party, that their health insurance will pay all of their medical bills. Unfortunately, this is not usually the case.

New laws have been passed at both Federal and Georgia State levels which have given health insurers rights of subrogation and rights of reimbursement. This means that if your health insurance company pays medical bills related to an injury caused by a third party, and you recover money from that party for your injury, your health insurance company may have the right to get their money back from you. Therefore, the insurance money they paid out under their contract with you became a loan which you may be required to pay back.

Every health insurance policy is different. Some are governed by Georgia law and some are governed by Federal law. In addition, there are different Federal laws which govern policies. So whether you are truly obligated to reimburse your health insurance company will depend largely on what law governs your policy.

Under Georgia law, some health insurers cannot recover money from you unless you have been “made whole” by the third party for all your damages, including but not limited to, medical bills, lost wages, and pain and suffering. This is a very difficult standard for health insurance companies to prove, and often, they will either abandon their claim or offer to significantly reduce it if Georgia law governs the policy.

Unfortunately, Federal law can be much more difficult for Plaintiffs in matters of subrogation. If your health insurance policy is governed by Federal law, you may end up paying back substantially more than under Georgia law.

The best way to determine which law governs your policy is to look at the policy itself. However, these policies can be difficult to understand. Unlike some other firms that settle your case and leave you to fend off the health insurance company on your own, at Kaufman Law we stand by your side every step of the way, and we will determine which law governs your health insurance policy and do our best to minimize or eliminate the amount of money you are required to reimburse them. We have over thirty years experience representing the injured in Georgia and making sure they get everything they are entitled to. Let us put our experience to work for you. Call us now.