Robert Hammers | December 19, 2025 | Personal Injury
If you are injured in an accident, you may be concerned about paying medical bills. You could be entitled to compensation for economic and non-economic damages if another party caused your injuries. However, until you settle a personal injury claim, you are responsible for paying the medical costs.
In many cases, an injured party uses health insurance to cover the medical expenses after an accident. However, health insurance companies have specific rights to demand reimbursement of the amounts they paid if you receive a personal injury settlement. Understanding these rights is essential to protecting your best interests.
What Are Subrogation Rights in a Georgia Personal Injury Case?
When someone is injured in an accident, health insurance often pays for medical treatment right away. This allows the injured person to get care without waiting for a lawsuit or settlement to end.
If another person caused the injury and the injured person later receives a settlement or court award, the health insurance company may ask to be paid back for the medical bills it covered. This right to request repayment is known as subrogation.
In simple terms, subrogation means a health insurance company may try to recover some of its costs from a personal injury settlement. However, Georgia law places important limits on when and how this can happen.
The Made Whole Doctrine
Georgia follows a rule commonly called the Made Whole Doctrine. This rule is designed to protect injured individuals.
Under this doctrine, an injured person generally must be fully compensated for all losses before a health insurance company can seek repayment. Being “made whole” includes recovery for:
- Medical expenses
- Lost income
- Pain and suffering
- Other long-term effects of the injury
If a settlement or judgment does not fully cover these losses, the health insurer usually cannot require repayment of medical bills it paid.
You Cannot Collect Medical Costs Twice
Georgia law also prevents injured individuals from recovering the same medical expenses twice. If health insurance has already paid certain medical bills, the injured person cannot personally seek those same costs from the at-fault party.
The right to request repayment belongs only to the insurance company that paid the bills. Any insurance policy language that attempts to give the injured person this right is generally not enforceable under Georgia law.
Limits on How Much an Insurer Can Recover
Even when a health insurance company is allowed to pursue subrogation, its rights are not unlimited. Insurers must clearly identify what they are seeking to recover, and the amounts claimed are often negotiable—especially when settlement funds are limited.
Georgia law also limits how much insurers can claim for attorneys’ fees and costs related to subrogation. These restrictions help prevent insurance companies from reducing an injured person’s recovery more than the law allows.
Employer Health Plans and Federal Law (ERISA)
Some health insurance coverage comes from employer-sponsored plans governed by federal law, commonly referred to as ERISA plans.
In certain cases, ERISA plans may have stronger repayment rights than regular health insurance policies. Depending on the specific language of the plan, an insurer may be allowed to seek reimbursement even if the injured person was not fully compensated.
Courts look closely at the wording of these plans. If the language is unclear, Georgia’s state-law protections may still apply.
Medicaid and State Healthcare Liens
When Medicaid pays for medical treatment related to an injury caused by another party, the state may assert a lien against any settlement or judgment. Medicaid’s recovery is limited to the reasonable value of the care it provided.
Attorney’s fees and litigation costs are typically paid first, which reduces the amount Medicaid can recover.
Workers’ Compensation Subrogation
In addition to health insurance subrogation, workers’ compensation insurers have subrogation rights when a third party causes injury. In Georgia, employer/insurer subrogation rights apply only after the claimant is fully compensated.
Subrogation amounts are limited to sums already paid under workers’ compensation benefits.
Practical Advice for Injured Parties in Georgia Regarding Subrogation Rights and Personal Injury Settlements
Subrogation issues can directly affect how much compensation an injured person ultimately receives. To avoid these issues, injured individuals in Georgia should keep the following practical considerations in mind:
- Subrogation claims may be negotiable: Health insurers are not always entitled to full reimbursement, particularly when the injured person has not been made whole under Georgia law.
- Account for subrogation when reviewing settlement offers: Health insurance reimbursement claims, ERISA plans, and Medicaid liens can significantly reduce net recovery and should be considered before accepting any settlement.
- Confirm that subrogation is addressed by legal counsel: Attorneys handling Georgia personal injury cases should understand how state and federal subrogation laws affect settlements and client recovery.
Identifying and addressing subrogation issues early can help prevent unexpected reductions and provide a clearer picture of a personal injury claim’s true value.
An Atlanta Attorney Can Help With a Georgia Subrogation Claim
Some personal injury claims may not require legal representation. However, it is wise to seek legal advice after an accident or personal injury. Insurance companies look out for their best interests. If you do not have an attorney, you might not realize that the insurance company is taking more money for a subrogation claim than allowed by law.
If you have questions about subrogation rights or personal injury claims in Georgia, contact Hammers Car Accident & Personal Injury Lawyers. Our Atlanta personal injury lawyers offer free consultations.
We serve Fulton County and its surrounding areas:
Hammers Car Accident & Personal Injury Lawyers – Atlanta
201 Joseph E Lowery Blvd NW Suite 312, Atlanta, GA 30314
Open 24/7
(770) 900-9000
Hammers Car Accident & Personal Injury Lawyers – Sandy Springs
5555 Glenridge Con, Suite 975, Sandy Springs, GA 30342
Open 24/7
(678) 990-7024
Hammers Car Accident & Personal Injury Lawyers – Lawrenceville
265 Culver St S. Suite A. Lawrenceville, GA 30046
Open 24/7
(678) 626-5067
Hammers Car Accident & Personal Injury Lawyers – Mableton
5701 Mableton Pkwy SW Suite 108, Mableton, GA 30126
Open 24/7
(706) 480-5487
Hammers Car Accident & Personal Injury Lawyers – Smyrna
2400 Herodian Way Ste#220, Smyrna, GA 30080
Open 24/7
(678) 922-4497
Hammers Car Accident & Personal Injury Lawyers – Roswell
110 Mansell Cir #111, Roswell, GA 30075
Open 24/7
(678) 582-8466
About Robert M. Hammers Jr.
Robert M. Hammers, Jr. is the managing partner at Hammers Car Accident & Personal Injury Lawyers in Atlanta. Committed to justice, he represents individuals harmed by negligence, focusing on personal injury litigation.
With over 50 jury trials and $100 million in verdicts and settlements, Rob is known for his strategic thinking and dedication to achieving the best outcomes for his clients. He serves on the Executive Committee for the Georgia Trial Lawyers Association, the American Association for Justice Board of Governors, and the Plaintiff Leadership Committee in complex multi-district and toxic tort litigations, where he advocates for injured individuals and shapes legal strategies.
Robert is also recognized on Justia for his excellence in personal injury law, further highlighting his reputation and commitment to client advocacy.<a href=”//a.gotoloc.com/uber/F3IqS6yGWWgXrw”><img src=”//a.mktgcdn.com/uber/button.png” alt=”Ride there with Uber” /></a>
