Subrogation Rights by Health Insurance Companies: How They Can Impact Your Personal Injury Case

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Dive into the complexities of subrogation rights by health insurance companies with The Dressie Law Firm. Learn how these rights affect your personal injury claim and how we can guide you through the process.

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What Is Subrogation?

Under Georgia law, a person who suffers a personal injury due to the fault of another can claim compensation from the at-fault party or their insurance company. However, processing such claims takes time, and the injured party’s personal insurance company may have covered the initial medical bills, especially if they needed urgent medical attention.

In such cases, the injured party’s insurance company may have a right to seek reimbursement of the funds paid out if the injured party subsequently secures compensation from the at-fault party. This is formally known as a subrogation right.

When successfully exercised, a health insurance company’s subrogation rights can affect the amount of money an injured party is left with after a personal injury settlement. However, the right to subrogation is not absolute. Strict legal conditions must be met for this right to become enforceable. Being aware of those conditions is crucial so you are better equipped to protect your hard-won compensation.

Our skilled lawyers at the Dressie Law Firm can offer proactive legal guidance and representation to ensure you are not forced to give up your settlement or portions of it unfairly. So, if you’ve received a subrogation claim from your health insurer, do not worry. As a leading personal injury law firm in Atlanta, Georgia, we are here to help you secure your rights and interests.

Below, we explain the fundamental principles of health insurance subrogation in Georgia and share specific ways we can help with your case. Read on to learn more.

    When Will an Insurance Company Have the Right to Subrogation?

    The right to insurance subrogation in Georgia is not automatic in all cases where a personal injury victim’s medical costs and related expenses were covered by their health insurance company.

    Under the Georgia Code § 33-24-56.1, the right to subrogation will only arise if the amount the injured party recovered from the at-fault third party exceeds the economic and non-economic losses or damage they suffered due to their injury.

    Essentially, you have the right to challenge or refuse a subrogation request if the amount you received from the at-fault party does not cover all your losses due to your injury.

    However, your health insurance provider can still approach the court to resolve the issue upon your refusal. If the court determines that the third-party settlement does not fully compensate you, then the insurance company will have no right to reimbursement. 

    This legal provision adapts a legal principle known as the made whole doctrine. According to this doctrine, subrogation cannot be allowed if an injured victim is not fully compensated for all their injuries, both physical and psychological.

    Even if you’ve recovered from your physical injuries, we know that no amount of money can ever put you back in the position or mental state you were in before your injury. Our skilled lawyers can work to help you demonstrate this (absence of a full recovery, no matter how minimal), which could be sufficient to eliminate a subrogation claim.

    ERISA Health Insurance Plans and the Right to Subrogation 

    The Employee Retirement Income Security Act (ERISA) is a federal law that governs certain retirement and health insurance plans. As a federal law, the ERISA supersedes the provisions of Georgia state law. So, if your health insurance is ERISA-based, subrogation might be possible even if the conditions under Georgia law have not been met. 

    In such cases, there might be ways to limit the amount you’d have to reimburse. You’ll need to contact a personal injury lawyer to learn more about your options in such circumstances.

    Time Limits to Subrogation Claims

    If you’ve received insurance payouts from your insurance company and you intend to pursue a personal injury claim against the at-fault party, you are required to notify your insurance company about the claim at least ten days before a settlement is reached or the court trial begins.

    The insurance company must respond to the notice with its detailed reimbursement request before the trial begins or a settlement is reached. If they fail to send the request within the permitted period, then their right to subrogation will be extinguished. 

    However, if you fail to send the initial notice, they can bring a subrogation claim against you after you receive the settlement or judgment.

    How Much Can the Insurance Company Claim?

     Even if an insurance company meets the legal conditions for subrogation, that doesn’t mean they are entitled to the entire settlement recovered by the injured party.They are only entitled to the amount awarded for the category of expenses they covered. 

    For example, if the insurance company only covered medical expenses, they can only recover the amount allocated to medical expenses in the settlement or judgment. They cannot touch other parts of the settlement, e.g., the amount awarded for pain and suffering.

    Also, the injured party’s legal expenses incurred to pursue the third-party compensation claim must be deducted from the amount claimed through subrogation. So, the insurance company must be willing to bear the cost of your attorney’s fees and legal expenses associated with the third-party claim before they can obtain a reimbursement.

    Subrogation Rights by Health Insurance Carriers: Prohibited Modes of Enforcement

    An insurance company seeking reimbursement for expenses can only exercise its subrogation right through pre-litigation negotiations with the injured party or through the court process.

    They cannot;

    • Deprive the injured party of present or future insurance benefits to compensate for their expenses.
    • Contact or negotiate with the at-fault party or their insurance company or take legal action against them for reimbursement.

    If your insurance company takes such steps, you may be able to file a lawsuit against them. But you’ll need to contact a lawyer who can assess your case and determine the full extent of your rights.

    Navigating Subrogation Claims With the Dressie Law Firm

    At the Dressie Law Firm, we understand the nuances of dealing with health insurance companies and the subrogation process. When you’re injured due to someone else’s negligence, our focus is not just on your recovery; it’s on ensuring that your financial compensation is maximized.

    Subrogation claims can adversely affect your financial compensation. We are here to eliminate their impact or reduce them as much as possible.

    Our Approach to Insurance Subrogation Cases

    • Insurance Policy Review: Usually, we start by thoroughly reviewing our client’s health insurance policy to identify any subrogation clauses.
    • Assessment of Claims: Next, we assess the total impact of the client’s injuries, their recovery level, and how subrogation might affect their compensation.
    • Strategy Formulation: We develop personalized legal strategies tailored to the client’s specific case to ensure the best possible outcome 
    • Negotiations/Courtroom representation: Depending on the circumstances, we can negotiate with insurance companies to reduce the amount claimed as reimbursement to help our clients avoid the rigors of litigation. But we are not afraid to proceed to court if that would offer our clients the best chance of success.

    Trust us to guide you through the complex process of subrogation claims, ensuring you retain as much of your personal injury settlement as possible.  Your well-being is our concern, and we’d be glad to help you reduce the burden of the subrogation claim and secure your personal injury compensation.

    Reach Out to Us

    Subrogation rights allow health insurance companies that cover the initial costs of a third-party injury to claim reimbursement from their policyholders after a settlement or compensation award. However, this right is based on the fulfillment of several conditions, including the full recovery of the injured party to ensure they are made whole. 

    As experienced personal injury lawyers in Georgia, we know that the trauma of serious injury may never go away, even if the physical signs do. It is only fair that you get to keep the compensation you’ve secured due to the damage you’ve suffered, or at least most of it. 

    That’s what we hope to help you achieve. So, if you’re dealing with a subrogation claim after a car accident or any other type of injury, do not hesitate to contact us. Let us assess your case, clarify your rights, and guide you as you enforce them.

    The Dressie Law Firm Can Help You

    If you or a loved one is a victim of a reckless or negligent driver, we want you to know that the law is on your side and so is the Dressie Law Firm.

    Contact us today to schedule your free consultation!