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Duffy & Feemster

Can your health insurer deny payment of your medical bills from an accident?

Your insurance company is seeking to reduce their exposure to your claim because there may be another party whose negligence caused you to incur medical expenses. In those situations, the health insurance carrier likes to try to get a reimbursement  of the amount that they pay for your medical bills from the insurance company that provides insurance for the at fault party.  If this reimbursement occurs it will often reduce or eliminate any recovery by you from the at fault party’s insurance carrier for your claims.  However, Georgia law provides that no insurance company can obtain a reimbursement unless you are fully compensated for all your claims and damages. This is called the “made whole doctrine”.   

Georgia law also provides that no insurance carrier can reduce the amount for which it is responsible for medical bills as a set-off against any claim for reimbursement that it may make in the future, nor can an insurance company withhold or set-off insurance benefits as a means of enforcing a claim for reimbursement.  This is a complicated area of law and is evolving very rapidly. However some insurance policies are governed by federal law which is different Georgia state law.  

Your insurance company’s right to reimbursement depends on what type of insurance policy you have and also depends on what other insurance might be available.  We can help you with this issue.  If you have any questions about this, please do not hesitate to call us at (912) 236-6311.

Dwight T. Feemster
Dwight is a civil and criminal attorney in Georgia.

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