Most people believe that when they are injured in a car wreck where the other driver is at fault, that the driver or their insurance company will be responsible for paying the medical bills as they arise.
Unfortunately, this is not the case. The truth is that if they are found to be at fault for your injuries because of their negligence, they will then be responsible to YOU for the bills related to the wreck. They are NOT responsible to the medical providers. An injured person will not be able to simply refer their medical providers to the other person’s insurance coverage when it’s time to pay.
This means that you still have to pay your medical bills yourself, or more usually, submit them to your own health insurance if you have it. And if you use your health insurance or Medicare/Medicaid to pay your hospital bills after a crash, as most of our clients do, the health insurance coverage provider will want you pay them back after you receive your settlement money.
Why Do I Need to Pay Back My Health Insurance If I Settle My Case?
This is because of subrogation/reimbursement laws which allow insurance companies to be reimbursed for what they have paid out IF you collect compensation from a third party.
Let’s say you were injured in a car crash and needed $10,000 of treatment, after which the hospital submitted the bills to your health insurance company for payment.
In Georgia, the law recognizes that the person or party that caused your injury is responsible for the bills, regardless of whether they were already paid by someone else (you, through your insurance company). The logic is that the responsible party should not benefit (by not having to pay) because you were prudent and paid the health insurance premiums to get treatment for your injury. Nevertheless, in many circumstances, health insurance providers (including Medicare, Medicaid, and Tricare) can ask to be reimbursed the amount they actually paid out if you get compensation from the responsible party.
In Alabama, the rules are a little different. In Alabama, the responsible party is still obligated to pay for the bills that arise from their bad decisions leading to your injury, but only to the extent necessary to reimburse the health insurance company itself and an amount you paid for premiums. In other words, the laws have been changed to give the negligent person (actually their insurance company) the benefit of the good decisions made by the injured person. There are exceptions and other factors involved, but the general idea was to limit what auto insurance companies had to pay back to health insurance companies – this is not for the benefit of injured people.
Will My Health Insurance Take All of My Settlement?
It’s complicated. At most, your health insurance company will only take an amount equal to what they paid; however, how much they take or if they take anything depends on even more factors. First, we must know if the health insurance is provided by your employer. If it is, then the health insurance coverage MAY have rights under Federal law to enable it to collect. If the coverage was purchased by you individually, or it is provided by an employer but is not a “self-funded” plan, then you may have more arguments against paying anything back at all, unless you as the injured party were “made whole.”
In some cases, your lawyer should be able to negotiate with the health insurance company to take less that what they have paid, although this is not a guarantee .
Regardless, you do get to keep the compensation for everything that wasn’t billed to your health insurance. For example, any money you received for your pain and suffering is yours to keep and do with however you like.
Are There Exceptions to Subrogation/Reimbursement?
In some, but not all, cases, injury victims in Georgia may not have to follow subrogation due to the state’s Made Whole Doctrine.
This doctrine states that the health insurance provider can only ask to be paid back if the injury victim has been “made whole,” a.k.a. fully recovered (which, in the eyes of the law, makes them fully compensated). If a victim still has ongoing medical expenses (if they are still receiving treatment or became disabled), they are not fully compensated yet for their injuries, so the insurance company doesn’t have a right to take away the compensation legally still owed to them. It can be argued that any case that is “settled” was the result of a compromise and, by definition, the injured person gave something up to get it done and was not actually made whole.
If you have questions about whether the Made Whole Doctrine applies to your injury claim, contact our experienced injury lawyers today.
Get a Lawyer to Help You Calculate What You Are Owed
Because the at-fault driver or their insurance cannot be billed directly for your medical expenses after a car crash, it is up to you to tell them how much money you need to cover all your medical expenses and other losses after a car crash. And your losses may add up to more than you realize, which is why we always recommend speaking to a lawyer before accepting any settlement.
Your accident-related expenses should include your hospital bills, prescriptions, and any recovery treatment like physical therapy, but may include a lot more. For example, if you became disabled because of your accident, you should also demand compensation for any accommodations to your home or car that are needed because of that.
You will likely be spending more on transportation costs because of all trips back and forth from doctor appointments, so you deserve compensation for what you spend on that. You may also need to hire childcare while you are recovering, which is an additional expense.
You are likely experiencing a lot of pain and stress, which you also deserve compensation for. It can be hard to be a dollar value on those damages, but all of these costs and more need to be considered.
An experienced personal injury lawyer can help you determine how much your accident has cost you and help you get a fair settlement. Insurance companies know that the average person doesn’t realize what their injuries are worth, so they will try to lowball you essentially every time.
Contact the Law Offices of Gary Bruce Today
At the Law Offices of Gary Bruce, we’ve seen just about every trick in the book when it comes to insurance companies saying you deserve less money than you do or trying to take more than they should in reimbursement. We also know exactly how to handle them.
If you’ve been in an accident that wasn’t your fault and need compensation, contact us today to learn what we can do for you.