What is Subrogation?


Most health insurance policies in Georgia have a “subrogation” paragraph. If you are injured in an accident, and they pay your medical bills, you have to repay them out of any case settlement or award you receive – with important limitations. Georgia law requires this repayment only after you are “made whole” for your reasonable attorney’s fees and costs, a reasonable amount for pain and suffering, your lost wages, and all the other expenses and losses you had because of the accident and your injury. Using this law, your attorney can negotiate to reduce or, in some cases, even eliminate, the required repayment.

If Medicare or Medicaid paid your medical bills for an accidental injury, the law requires you to repay them out of your settlement or award, and Georgia’s “made whole” law does not apply. However, at Stokes & Kopitsky, we have found that we can often negotiate the repayment amount down. First, we examine your medical bills to see how much they actually did pay; if they only paid $300 of a $1,000 bill, we make sure you don’t repay them for the full amount. Second, we can often negotiate with them to further reduce what you repay, sometimes by 30% to 50%.

If you were covered by an ERISA employee health benefit plan (one where your employer paid your health care bills from its own money), you may or may not have to reimburse that plan for your medical bills. Very complicated laws apply to ERISA health benefit plans, and it is crucial that our experienced injury attorneys study your specific plan’s policy language. Some ERISA plans are covered by Georgia’s “made whole” rule, and some are not; and we will start evaluating negotiation strategies for your particular plan early in your case.

If your medical bills were paid by Georgia state worker’s compensation, you have to repay them from your settlement or award, but Georgia’s “made whole” law usually applies. Again, as experienced injury attorneys, we can usually negotiate to reduce or even eliminate the amount you have to repay.

At Stokes & Kopitsky, our attorneys have years of experience in negotiating with all types of health care plans and government administrators. We know Georgia law, and we will use it to your best advantage to make sure you don’t have to repay any plan or agency any more than absolutely necessary out of your settlement or award.

We answer our phones 24/7, and your consultation is free. If we accept your case, we advance all costs, and there is no fee unless and until we obtain a settlement or court award for you. Please call us toll-free at 1- 404-892-0011 for highly qualified, experienced, caring legal help.

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