What Is Subrogation After a Georgia Accident?
Short answer: Subrogation is the right of an insurance company or health plan that paid your bills to be repaid out of the money you recover from the person who caused the accident. In Georgia, a state law known as the made-whole rule limits when many health insurers can collect.
Definition
Subrogation means substitution. The insurer steps into your shoes: once it pays for something the at-fault party should have paid for, it takes over your right to recover that amount.
Common examples after a Georgia crash:
- Your health insurance pays your ER and surgery bills, then claims part of your settlement.
- Your auto insurer pays to fix your car under your collision coverage, then goes after the at-fault driver’s insurer, often recovering your deductible along the way.
- Your medical payments (med pay) coverage pays some bills, and some policies ask to be reimbursed.
How it works in Georgia
- The made-whole rule: under O.C.G.A. § 33-24-56.1, a health insurer or other benefit provider can require reimbursement only if you have been fully compensated for all of your losses, and its recovery is reduced by its share of the attorney’s fees and expenses.
- Exceptions: self-funded employer plans governed by ERISA, Medicare and Medicaid follow their own federal or state rules and are not limited by the Georgia statute in the same way.
- Workers’ compensation: a separate lien statute applies when comp paid benefits (O.C.G.A. § 34-9-11.1).
Example
A driver with a $50,000 policy hits you, and your losses total $180,000. Your health plan paid $30,000 and wants it back. If the plan is covered by Georgia’s made-whole rule, you have not been fully compensated, so the plan may not be entitled to reimbursement. If it is a self-funded ERISA plan, different rules apply and the claim is usually negotiated.
Why it matters for your claim
- Liens decide how much of a settlement you actually keep.
- The type of plan that paid your bills changes the math.
- Many liens can be reduced, but only if someone checks them.
Read more: Who pays your medical bills while your Georgia injury case is pending? and Where your settlement goes before you receive your check.
Related terms
Frequently Asked Questions
Do I have to pay my health insurance back out of my settlement?
Sometimes. It depends on the type of plan and whether you have been made whole. Georgia’s made-whole rule protects you against many fully insured plans. Self-funded ERISA plans, Medicare and Medicaid follow different rules.
Can a subrogation claim be reduced?
Often. These claims are routinely negotiated, and where Georgia’s statute applies, the insurer’s recovery must be reduced by its share of the attorney’s fees and expenses.
Will my insurer go after the other driver for my deductible?
Usually, when your collision coverage paid for repairs. Ask your adjuster whether your deductible is included in their subrogation claim.
Browse the full Georgia personal injury glossary
Questions about how this applies to your accident? Call 888-BIG-GUNN or request a free case review. There is no fee unless we win.
This is general information about Georgia law, not legal advice for your situation.
