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After you settle or try a case to verdict, you may have to deal with a multitude of entities that will claim the right to be reimbursed for payments they made on your behalf. In addition to medical liens, which we previously discussed, if any of the following entities paid medical bills on your behalf, you may have to reimburse them.
Most automobile medical payments policies have language included in the contract that says they are entitled to reimbursement for bills they paid if you receive a settlement for those same bills. In Georgia though, there is a statute that protects consumers from having to reimburse these companies unless you settle your case for an amount that exceeds the total of all lost wages, medical bills, and pain and suffering. In practice, very few medical payments insurers are dumb enough to sue their own insureds to gamble that a court will rule that the case was settled for its full value.
Here is the statute:
Medicare is a government-funded program that provides health benefits. By law, it is a “secondary payor” which means it does not pay out until all other sources of money, including the at-fault driver’s car insurance, has paid out. Sometimes they will pay ahead of time and the payment will entitle the program to a lien against the proceeds of any settlement.
If Medicare pays out for medical care and you then receive a settlement or verdict for that medical care, they are entitled to be paid back. They will reduce the amount of their claim if you apply based on the following formula:
Understand that the process is complex and you should consult a lawyer. In 2010, there will be drastic changes to an injured person’s obligations to Medicare if they will have future medical care to be paid by Medicare.
If your medical bills were paid by this program, you must repay the benefits according to a specific percentage of the benefits paid. If you are dealing with a Medicaid repayment issue, you should consult a lawyer.
Health Insurance companies will almost universally claim a right to be reimbursed from your settlement proceeds for medical care they paid for. The analysis of whether your health insurance is entitled to reimbursement is complex and turns on the analysis of whether the plan is governed by Federal law or Georgia law. If Georgia law applies, then the plan is only entitled to reimbursement under O.C.G.A. §33-24-56.1 if you have been “made whole.” If the plan is controlled by Federal law, then the state law is pre-empted and you need to negotiate with the health insurer. Some will reduce their liens by as much as 50% if a lawyer is involved.
Determining whether Georgia law or Federal law applies is a complex analysis and you should always consult a lawyer if you are dealing with these issues.
If worker’s compensation paid for the medical care that underlies the personal injury claim that you are making, they will assert that they need to be repaid and under Georgia law, they can take several steps including filing suit or joining a lawsuit you already brought. Workers compensation companies are not entitled to be paid back from your case proceeds unless “the injured employee has been fully and completely compensated.” O.C.G.A. §34-9-11.1. If you are dealing with a workers compensation lien, you will need to get a lawyer involved.