GEORGIA INJURY LAWYER

The law under O.C.G.A. §33-24-56.1 is very specific as to when your health insurance benefits provider can obtain reimbursement from your personal injury settlement due to the health benefits they provided you because of the injury. The law states that your health insurance benefits provider can only obtain reimbursement it has paid on account of the injury up to the amount allocated to those categories of damages in the settlement documents or judgment if they meet the following:

“1)The amount of the recovery exceeds the sum of all economic and noneconomic losses incurred as a result of the injury, exclusive of losses for which reimbursement may be sought under this Code section; and
2) The amount of the reimbursement claim is reduced by the pro rata amount of the attorney’s fees and expenses of litigation incurred by the injured party in bringing the claim.”

What does this mean for you? It means that only if an insurance company can prove that you have been fully compensated: “made whole” are they able to recover reimbursement. Here is an example to illustrate: let’s say you recovered $200,000 in a settlement for your personal injury claim, let’s also say the sum of all your economic and noneconomic losses totaled $300,000, and the insurance company paid $50000 in your medical bills for your injury which they are now seeking reimbursement. In this situation, the insurance company cannot go after your settlement money to get reimbursement because the sum of your recovery ($200,000) did not exceed your total economic and noneconomic losses, exclusive of losses for which reimbursement may be sought ($300,000-$50,000= $250,000).

However, if it did, we would then jump to the second prong of the statute which states that the amount of reimbursement still must be reduced “by the pro rata amount of the attorney’s fees and expenses of litigation incurred by the injured party in bringing the claim.”
Continue reading →

You’ve been injured in a serious accident and receive a $100,000 settlement for your injuries. Your health insurance company covered most of your medical bills. The question: Can your health insurance company seek reimbursement for all the medical bills they paid to treat your injuries? An effective attorney can help you with these questions.

Georgia statute §33-24-56.1 is known as the “Reimbursement Statute” under Georgia law. This law prohibits the insurance company from being reimbursed “if” you have not been fully compensated for all economic and noneconomic losses. §O.C.G.A. §33-24-56.1(b). Determining “if” you have been fully compensated requires a complete understanding of Georgia law because the issue is often complex.

Another important consideration is that O.C.G.A. §33-24-56.1(c) prohibits your health insurance company from withholding or reducing your coverage as a setoff for reimbursement. The law also prohibits insurance companies from creating policies or contracts that conflict with the law. O.C.G.A. §33-24-56.1. The law also sets forth a procedure to be followed by the you, the injured party in providing notice of the personal injury claim to the benefit provider (O.C.G.A. §33-24-56.1).

The point is clear: understanding the law when reviewing your policy is vital to maximizing your negotiating position with stubborn insurance companies, to help protect the compensation you receive, for the injuries you suffered.
Continue reading →