Did your health insurance pay your medical bills after a car accident in Monroe, Georgia?
If so, you may be wondering whether you will have to pay back your health insurer if you receive a settlement from the at-fault driver. The answer? It depends. Please see below a breakdown on whether you will have to pay back your health insurer after you receive a settlement.
NON-ERISA HEALTH INSURANCE PLANS
If your health insurance is not an ERISA plan, then you only have to pay back your health insurer after a settlement if you were “made whole” which means your settlement amount equals or exceeds the sum of all your economic and noneconomic losses you suffered due to the accident and that you were “fully and fairly compensated.”
In Georgia, it is very difficult for health insurers to prove you were fully and fairly compensated from a settlement, so most of the time you do not have to pay back your health insurer if it is a non-ERISA plan.
ERISA PLANS
First, you may be wondering, what is an ERISA plan? ERISA stands for Employee Retirement Security Act and is a federal law that sets standards for group health plans.
You may be wondering whether your health insurance plan is an ERISA plan. ERISA plans are only group plans, so if you have an individual plan, it is not subject to ERISA.
The easiest way to determine whether your health insurance plan is subject to ERISA is to request your plan documents from your employer and/or health insurer. The specific documents you should request are the master plan, summary plan, Form 5500, and Schedules A and C.
A review of these documents will allow you to determine whether the plan is an ERISA plan.
If you determine your plan is an ERISA plan, the next step is to determine whether your plan is self-funded or funded by insurance.
SELF-FUNDED ERISA PLANS
If the plan is self-funded, which means your employer is funding the medical costs of the plan, then you most likely will have to pay back your health plan for the medical bills it paid for your injuries from the accident.
However, if the plan documents fail to say that the made whole doctrine does not apply to benefits paid due to accidents caused by third parties, you may be able to argue that the made whole doctrine applies and you are only obligated to pay back your health plan if you were “made whole” and “fully and fairly compensated” from the accident.
INSURANCE FUNDED ERISA PLANS
If your ERISA plan is funded by insurance, then the made whole doctrine will apply, and you only have to pay back your health insurer if you were “made whole” and “fully and fairly compensated” from the accident.
CONTACT BARTLETT BENTON
If you were injured in a car accident in Monroe, Georgia and would like a free case evaluation, please call Bartlett at 770-365-6414.