After you win or settle your personal injury case, you often have to deal with paying your medical bills. And if your medical bills were paid by Medicare, Medicaid, health insurance, worker’s compensation or medical payments coverage, you also have to deal with repaying them. Let’s look at who has to be repaid after your personal injury case and why.
IMPORTANT TO KNOW
It’s very important to understand that your repayment obligation is limited to what Medicare, health insurance or worker’s compensation paid, not the total amount of the bill. If your hospital bill was $25,000 and health insurance only paid $10,000, your repayment obligation is $10,000, the amount that health insurance paid.
It’s also important to understand that if you do not make a financial recovery in your personal injury case, you do not owe Medicare, Medicaid, health insurance or worker’s compensation for your medical bills. If you have unpaid medical bills, you still may be financially responsible.
MEDICAL LIENS
If you have an unpaid bill from a personal injury case, doctors and hospitals have the right to file a medical lien against the case to make sure that they are repaid from the verdict or settlement. The lien is against the case only, not you or your house or your personal property. An attorney can usually negotiate a reduction in the amount of the lien. The amount of the reduction depends on the factors of each individual case and there is no set or standard reduction.
MEDICARE & MEDICAID
If Medicare paid your medical bills, federal law requires that you repay Medicare 100% of what it paid out of the verdict or settlement. Again, an attorney can usually negotiate a reduction in the amount that Medicare wants to be repaid and the amount of the reduction depends on the factors of each individual case.
If Medicaid paid your medical bills, you are generally required to repay Medicaid but under federal and Georgia law an attorney has more leverage in negotiating a reduction in the amount you have to pay and can usually negotiate a greater reduction.
HEALTH INSURANCE
If you have health insurance and it paid for your medical bills, whether or not you have to repay it depends on what sort of health insurance you have. If you have ERISA health insurance and it is “self-funded,” meaning your employer pays your medical bills out of its own pocket, federal law requires that you repay health insurance 100% of what it paid. If your insurance is not ERISA and is not “self-funded,” such as health insurance you buy on the federal health care exchange, you generally do not have to repay it.
Even if you have ERISA health insurance and it is self-funded, an attorney can sometimes negotiate a discount in the amount you have to repay but it depends on the facts of your specific case.
WORKER’S COMPENSATION
If you were injured on the job and worker’s compensation paid your medical bills and the time you missed from work, worker’s compensation has a claim to be repaid out of your personal injury verdict or settlement. However, under Georgia’s “made whole” law you do not have to repay worker’s compensation unless the financial recovery fully and completely compensates you for your injury. As a practical matter, injured people are almost never financially “made whole” for their injuries and as a result you usually do not have to repay worker’s compensation for the medical bills and lost wages it has paid.
MEDICAL PAYMENTS COVERAGE
If you’re hurt in a car wreck, your insurance policy may have medical payments coverage that will pay for your medical bills. The amount of coverage depends on your policy. Like worker’s compensation, you don’t have to pay back medical payments coverage unless you are “made whole” for your injury by the financial settlement. As a practical matter, you usually do not have to repay medical payments coverage.