December 6, 2019

Pitts Carr and Alex Weatherby

Do I have to pay my insurance company back in a personal injury case?

After a truck accident, wrongful death accident, brain injury accident, spine accident, or any other serious personal injury, there is often a large amount of medical bills. Whether or not the injured person has insurance, the bills will need to be paid from the settlement funds.

When a health insurance company has paid for the medical treatment, the insurer has a contractual right to subrogation. This is a fancy legal word that essentially means: the insurance carrier is entitled to recover from the injured party for any payments in medical expenses it incurred related to the accident. The policy behind this rule is that the injured party is otherwise receiving a double payment. That is, payment from the health insurance carrier for medical bills and payment from the defendant for medical bills.

Putting aside whether that is the case, it is the law. There are some defenses to a health insurer’s subrogation. Most of the time, the health insurer’s lien is governed by O.C.G.A. § 33-24-56.1(b). This statute essentially states that the health insurer can recover medical expenses from the injured party if (1) there is an “amount allocated to those categories of damages in the settlement documents” and (2) “the amount of recovery exceeds the sum of all economic and noneconomic losses.” It is important to note that case law has generally found that it is a factual dispute whether the settlement agreement provided for medical bills and whether the recovery is large enough to permit the insurer to recover.

If a health insurer is not involved, the hospital or medical provider may assert a lien on the proceeds. This lien is granted by statute as well, O.C.G.A. § 44-14-470. The charges the hospital or medical provider is charging must still be reasonable, which can be up for some debate.

A reputable Atlanta truck accident attorney, Atlanta bike accident attorney, Atlanta brain accident attorney, Atlanta spine injury attorney can help you navigate this field. We have extensive experience in Atlanta truck accidents, Atlanta bike accidents, Atlanta brain accidents, Atlanta spine accidents, and other catastrophic injuries as well. We offer free consults. We practice throughout Georgia, including Gainesville, Columbus, Savannah, Albany, Macon, Decatur, Augusta, Athens, Sandy Springs, Roswell, Johns Creek, Warner Robbins, Alpharetta, Marietta, Smyrna, Dunwoody, Peachtree City, East Point, Newnan, Douglasville, Kennesaw, LaGrange, Lawrenceville, Duluth, Acworth, Cartersville, Snellville, Fulton County, Gwinnett County, DeKalb County, Cobb County, Cherokee County, Henry County, Richmond County, Muscogee County, Hall County, Forsyth County, Bibb County, Paulding County, Douglas County, Coweta County, and Clarke County.