The Nelson Law Group

Unpacking Health Insurance Reimbursement After an Auto Accident: What You Need to Know

By Pierce Blitch

You’ve recently been injured in an automobile accident. The medical bills have started coming in the mail. You may have asked yourself, “will I have to reimburse my health insurance provider?” The short answer is: “It depends.” Let’s break down what this means for different types of health insurance plans.

Two Main Types of Health Plans

Paid Premium Insurance Plans
: These are either group insurance plans from your workplace or ones you buy directly from the market.

Self-Funded ERISA Plans
: These plans are not about paying premiums for a potential need but involve you and your employer contributing to a fund that covers medical expenses directly. ERISA (Employee Retirement Income Security Act) is a federal law that sets rules to protect people who participate in retirement and health plans at their place of work. ERISA ensures that plans are managed fairly and that the money put into the plans is safe. Also, ERISA gives workers information about their plans and ensures they get their benefits when they need them. ERISA plans are not about paying premiums for a potential need, but involve you and your employer contributing to a fund that covers medical expenses directly.

Understanding Self-Funded ERISA Plans

Larger companies often opt for these plans due to their assets, but smaller firms might choose them too. What’s tricky is that these plans often hire companies like UnitedHealthcare or BlueCross BlueShield to manage them, making it appear as typical health insurance. However, these are fully self-funded plans. To truly understand what you’re dealing with, you’ll need to look at the Form 5500 and Plan Documents.

The Legal Landscape of Reimbursement

In Georgia, how much you need to pay back depends on whether your plan is fully self-funded under ERISA or a regular health insurance plan. For fully self-funded plans, you’ll likely need to reimburse most, if not all, of what was paid on your behalf, depending on specific plan terms. However, for standard health insurance, the insurer must prove that your financial recovery from a settlement or verdict has fully compensated you—often a difficult task. This could mean you might not have to pay back much, if anything at all.

How We Can Help

Navigating the complexities of insurance reimbursement can be a daunting task for someone unfamiliar with the process, especially for a person who may be dealing with the pain and suffering of a recent car wreck. The attorneys at the Nelson Law Group are here to help you obtain the compensation you deserve and answer any questions you have along the way about the process.


We fight for you, and we don’t back down. Every personal injury case has potentially life-altering consequences. We don’t hold back on providing our clients the best possible representation. At The Nelson Law Group, we understand the physical, emotional, and financial toll a personal injury case can take. If you, a family member, or a close friend has been injured due to someone else’s negligence, 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 dedicated personal injury strategies with one of our compassionate and 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.
Categories: ERISA, Health Insurance, Personal Injury, Car Accidents