If you are a Georgia resident who was injured in an auto accident, you may be wondering how your medical bills will be paid and whether you have to reimburse your health insurance company for the expenses it covered. The answer depends on what type of health insurance plan you have and whether you have any other sources of coverage, such as medical payments coverage or uninsured motorist coverage. In this blog post, we will explain what an ERISA health plan is and how it differs from an ordinary health insurance plan. We will also discuss why it is important to have an attorney represent you to avoid health insurance subrogation and reimbursement issues or minimize their effect on your settlement.
What is an ERISA Health Plan?
ERISA stands for the Employee Retirement Income Security Act of 1974, a federal law that regulates employee benefit plans, including health insurance plans offered by employers. ERISA plans are usually self-funded by the employer, meaning that the employer pays for the medical expenses of its employees directly rather than purchasing a policy from an insurance company. ERISA plans are governed by federal law and are exempt from state laws that regulate insurance.
How Does an ERISA Health Plan Differ from an Ordinary Health Insurance Plan?
One of the main differences between an ERISA health plan and an ordinary health insurance plan is that an ERISA plan has a right of subrogation or reimbursement against any recovery you obtain from a third party who caused your injuries. Subrogation means that the ERISA plan can step into your shoes and pursue a claim against the at-fault party for the amount it paid for your medical expenses. Reimbursement means that the ERISA plan can demand that you pay back the amount it paid for your medical expenses out of any settlement or judgment you receive from the at-fault party.
An ordinary health insurance plan may also have a right of subrogation or reimbursement, but it is subject to state laws that limit or restrict its ability to enforce such rights. For example, Georgia has a "made whole" doctrine that prevents a health insurer from recovering anything from your settlement unless you have been fully compensated for all your damages. Georgia also has an "anti-subrogation" statute that prohibits a health insurer from subrogating against its own insured.
Why Do You Need an Attorney to Deal with Health Insurance Subrogation and Reimbursement Issues?
Health insurance subrogation and reimbursement issues can be complex and confusing, especially when dealing with an ERISA plan that is not bound by state laws. If you do not have an attorney representing you, you may end up paying more than you should to your health insurer or losing a significant portion of your settlement to its claim. An attorney can help you:
- Identify what type of health insurance plan you have and what rights it has against your recovery
- Negotiate with your health insurer to reduce or waive its claim
- Challenge any unreasonable or invalid claims by your health insurer
- Protect your rights under state laws that may limit or prevent subrogation or reimbursement
- Maximize your net recovery after paying off any valid claims by your health insurer
If you are a Georgia resident who was injured in an auto accident and need help with your medical bills and health insurance issues, contact us today for a free consultation. We have experience handling cases involving ERISA plans and other types of health insurance plans. We will fight for your best interests and ensure that you get the compensation you deserve.