Unfortunately, after you pursue an injury case and receive a financial award, it is possible that you will have to reimburse various people and/or companies. Aside from medical liens, here are some common types of reimbursements that you may have to pay.
Most car insurance companies stipulate that if a client is injured in a car accident and requires payment of medical bills, the company expects to be repaid once the client receives a settlement intended to cover those medical bills. However, here in Georgia, the law states that insurance companies’ clients do not have to reimburse the company as long as the settlement amount does not exceed the total cost of all lost wages, pain and suffering, and medical expenses. In reality, insurance companies very rarely sue their own clients for reimbursements.
This statute ,O.C.G.A. §33-24-56.1, outlines, in part, the following points:
Because Medicare is government-funded, it is considered a “secondary payer”, meaning that it does not pay clients until every other financial source, such as the at-fault driver’s insurance policy, has paid the victim. At times when Medicare does pay its holders earlier, the program is entitled to a lien against the settlement amount that the victim ultimately receives.
In other words, if Medicare pays your medical bills and you later receive a settlement intended to cover those same medical bills, then Medicare will request to be reimbursed. You can use this formula, however, to minimize the amount that you have to pay:
As you can see, this is a complicated system, and it generally requires legal guidance to be carried out correctly. As of 2011, there have been major changes to these policies that might affect you, so be sure to discuss them with your lawyer.
If Medicaid has paid your medical bills after an accident, you will be required to reimburse these payments based on a certain percentage of the amount you received in benefits from Medicaid. If you are in this situation, you should contact a lawyer to help you sort everything out.
You can usually assume that your health insurance provider will request that you reimburse the bills that they paid on your behalf. But determining exactly what you are required to pay is a complicated process, depending on whether your health insurance plan operates under Georgia law or Federal law. If your plan is governed by Georgia law, then your health insurance company is only entitled to the specific reimbursements outlined under statute O.C.G.A. §33-24-56.1. Otherwise, if your plan is governed by Federal law, then state law no longer applies and you will need to negotiate the reimbursement with your insurance provider. Hiring a lawyer is important in this case because some insurance companies reduce the amount they require by up to 50% if a lawyer is handling the case.
If you have received worker’s compensation for your medical bills, then you will surely be asked to repay the costs after receiving a settlement. Under Georgia law, worker’s compensation companies have the right to file suit or even to join your own injury lawsuit. However, the company is not actually entitled to reimbursement unless you have been “fully and completely compensated” by your settlement. O.C.G.A. §34-9-11.1. It is rare that a party is able to settle their case for full compensation and workers’ compensation carriers have a very hard time proving this to the Court. You should talk to your lawyer about how best to handle this situation.