When you have a serious personal injury, whether it is a scooter accident, truck accident, pedestrian accident etc., there is often a lot of medical bills. If you are fortunate enough to have health insurance, all of your medical bills should be submitted to your insurer if at all possible. This is because, at the end of your case if you receive a settlement, you will have to pay for the medical treatment you received.
Under Georgia law, in general, a health insurer has weaker rights to recover medical expenses paid than a hospital or doctor directly. O.C.G.A. § 33-24-56.1 (b) states as follows:
In the event of recovery for personal injury from a third party by or on behalf of a person for whom any benefit provider has paid medical expenses or disability benefits, the benefit provider for the person injured may require reimbursement from the injured party of benefits 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:
(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.
In simple terms, this means that the insurer can recover funds only if the insurer can prove that the patient received more money than the claim of medical expenses and pain and suffering was worth. This is a tough road to hoe. Accordingly, in general, you will have to pay the health insurer less money out of pocket from your settlement.
In addition, the health insurer has negotiated rates with its medical providers that are lower than uninsured rates. This means the total amount owed will also be lower, making the amount you pay back less too.
There are exceptions to this rule, like with an ERISA employee funded plan. ERISA plans are governed by Federal Law, and the plan terms often require full reimbursement. There still may be some argument about the reasonableness of the charges or other arguments to reduce the amount owed. However, in general, a patient will be required to repay an ERISA plan more funds than a state-regulated insurer.
If you are uninsured, then the hospital or medical provider may provide treatment on a “lien.” Just like a contractor has a lien on their work on a home, a medical provider will have a lien on the treatment they provide. Sometimes the medical provider will require you to personally sign acknowledging the lien. Other times, they will simply file the lien with the County or otherwise make you aware of it. In most cases, unless the medical provider messes up its lien rights, you will be paying back something to the provider. It will typically be more than an insurer due to stronger rights of the provider and higher charges on the front end.
In general, an attorney cannot pay for medical bills, in Georgia, except in very limited circumstances for diagnostic and related treatment. Because of the risk of a conflict of interest, most lawyers are hesitant to advance even those payments. In our experience, juries do not like it when a lawyer is involved in the medical care of a client.
A knowledgeable Georgia attorney, like us, can help you navigate all aspects of your case, including these. We specialize in Atlanta truck accidents, bike accidents, brain injuries, spine injuries, amputations, and similar serious injuries.