The Nelson Law Group

The Maze of Health Insurance Reimbursement in Georgia Personal Injury Cases

By Pierce Blitch

When you’re grappling with the aftermath of a car accident or other personal injury, understanding the interplay between your health insurance benefits and your settlement can feel like navigating through a legal labyrinth. The statutes in Georgia, specifically O.C.G.A. §33-24-56.1, lay out precise conditions under which your health insurance benefits provider can lay claim to a portion of your personal injury settlement. These rules are designed with your protection in mind.

Understanding the Legal Framework

Let’s dive into the legal requirements that must be met for a health insurance provider to legitimately seek reimbursement:

  1. The Threshold of Recovery: Your settlement needs to surpass the total of all your calculated economic (items such as medical bills and lost wages) and non-economic damages (items such as pain and suffering), excluding the losses for which your health insurance seeks reimbursement.
  2. Fair Share of Legal Costs: Even when the above condition is met, the health insurance’s reimbursement claim must be proportionally decreased by the share of attorney fees and litigation expenses you’ve borne to secure your claim.

To put this into perspective, imagine you’ve been awarded $200,000 for your personal injury claim. If your total damages amount to $300,000 and your insurer has covered $50,000 for medical expenses, they are not entitled to reimbursement. Your recovery hasn’t exceeded the net loss ($300,000 – $50,000 = $250,000).

However, if your recovery does exceed this net loss, the insurer’s claim for reimbursement still needs to be adjusted for the attorney fees and litigation costs you’ve incurred.

Exceptions to the General Rule

It’s important to note that this reimbursement rule doesn’t interfere with the subrogation rights under Workers’ Compensation (O.C.G.A. section §34-9-11.1) or federal subrogation liens, including ERISA plans, Medicare, and others.

The Path Forward

Navigating these legal nuances demands the expertise of a seasoned attorney, especially to ensure you maximize your compensation from your personal injury claim.

In conclusion, understanding the intricacies of health insurance reimbursements in the realm of personal injury claims in Georgia is vital to your personal injury case. It ensures that your rights are protected, and your compensation is maximized. The statutes are specific, but the scenarios are diverse. Consulting with a knowledgeable attorney can provide you the clarity and direction needed in these challenging times.


We fight for you, and we don’t back down. We don’t hold back on providing our clients the best possible personal injury representation available. If you, a family member, or a close friend has been injured in a car accident or other personal injury, contact The Nelson Law Group today at 706-434-8770 or visit us at 7004 Evans Town Center Blvd., Third Floor, Evans, Georgia 30809 to discuss your unique case and our creative strategies with one of our experienced attorneys.

DISCLAIMER: The content on this site is offered solely for informational purposes and might not represent the current law in your jurisdiction. None of the details provided here should be interpreted as legal advice from The Nelson Law Group or from the individual writer. Additionally, it is not meant to replace professional legal advice. Readers should not base their actions or decisions to abstain from actions solely on the information found in or available through this site. Instead, they should seek tailored legal or other expert counsel regarding their specific situation from an attorney or other professional authorized to practice in the reader’s state, nation, or other relevant licensing area