The Roch Law Firm, P.C.

Will Medical Providers Be Reimbursed If A Settlement Is Reached?


As a starting point, every case is different and it is really important that you, the injured party, get your medical debt repayment situation correct. Legally, some medical debt must be repaid from the settlement and some medical debt legally is not required to be repaid from the settlement but is still a debt that should be repaid. You should seek legal advice to make sure that you know the difference. In general, there are different levels of medical debt in terms of whether they’re required to be repaid from the settlement. The highest or strongest level of medical debt is medical debt where the federal government paid for the medical care and the medical care was paid for someone who is hurt at the hand of others. In that situation, the federal government is going to have a right to be reimbursed; that is a very strong right that pretty much trumps anyone else’s right and below this right is the similar state right to be repaid for benefits it paid for care caused by the negligence of others.

Below the Federal and State rights of reimbursements is Hospital liens. These liens accrue where a hospital pays for medical care, for instance, you go to the hospital and the bill at the hospital or with the doctor remains unpaid. If the hospital files a document with the court called a lien. Similarly if you have health insurance through an employer and it is set up a specific way through a program called ERISA, then in some instances, that debt has to be repaid but there are also some defenses to that. If you are working at the time that you were hurt and your debt was paid through worker’s compensation, then they may also ask to be repaid but there are defenses to them being repaid as well. Below that is all other medical debt. This is debt that you owe but you owe it in the same way that if someone mows your lawn than you owe that person for the cost of mowing your lawn. You have to repay them for mowing your lawn but if you don’t then they can sue you. You should pay all the medical debts from your claim, but whether or not you are legally required to from the settlement itself depends on the type of care. It is something that really you should seek an attorney’s advice to make sure you do it the right way.

What Happens Once A Claim Has Officially Been Filed?

If your claim is filed against an at-fault driver, Georgia law gives the other side 30 days to respond. Typically what will happen within those 30 days is they will send a letter to your attorney, which will state whether they will pay that demand. If they meet that demand, which means that they will accept and pay the demand, then your attorney and the other side will discuss the payment arrangements and the insurance company will issue a check. In other instances, the other side will respond and say that they will not pay what is demanded but they’ll pay some other amount. If your attorney agrees to that amount, then the negotiations continue and the check is issued. In other instances, your side and the other side simply cannot agree on an amount to settle. If you cannot do that, then it’s going to be up to you to decide whether or not to initiate litigation or to continue to negotiate. In cases where your claim is not against an at-fault driver but is a claim against your own insurance company, such as where the other driver is not identified like a hit-and-run driver, the other driver did not have insurance, or the other driver did not have enough insurance to cover your injuries, then when it is that type of a claim, then Georgia law gives the insurance company 60 days to respond.

What Defenses Do Insurance Companies Use To Avoid Paying Out On Claims?

As a starting point in terms of defenses that insurance companies use to avoid paying out on claims, it depends on whether or not the insurance company agrees that the other driver caused the wreck. If the insurance company believes that you might be responsible for causing the wreck, then certainly that is something that they will highlight as a defense. In Georgia, if they believe that the driver was partly responsible and you were partly responsible, then they can reduce the settlement based on the allocation of fault between the two drivers. In instances where they say that the wreck was completely their driver’s fault, they are still going to try to avoid paying you a full settlement and they’ll do this in several different ways.

They could argue that you’re not as hurt as you think you are. They could argue that your injuries are caused by something else. They could argue that your body part was injured already and that it was damaged from age or prior injury or they could argue that the doctors that you saw were too expensive. What we’re seeing more and more of with insurance companies is simply the technique of delay, delay, delay. If we have a claim where, for instance, your medical bills total a certain amount, in a lot of cases, we’re seeing the insurance company come at the medical expenses, or in some instances, offer less than the medical expenses in an attempt to shock our clients into accepting less. The goal in doing that is simply to delay. The longer that they keep the case open, in a lot of cases, their hope is that the claimant will become frustrated and accept less than their claim is worth. What can we do to avoid this? The simple answer is by continuing to put pressure on the insurance companies. We do this by giving them a short time to respond. If they do offer less than what is the fair value for the claim, then we promptly file suit and we litigate the claim.

For more information on Reimbursement Of Medical Providers, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (770) 345-7624 today.

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