What’s a Subrogation Claim and Can It Affect a Medical Malpractice Case?

When filing a claim for a medical malpractice case in Georgia, many victims are not aware of the possibility of receiving subrogation claims from their health insurance. Most have no idea what these are and how they may affect their case, including the potential need to reimburse their health insurance provider. Such information is usually provided by Georgia medical malpractice lawyers during the first consultations with their clients.

If you are preparing to file a malpractice claim, you too should consult a medical malpractice attorney and discuss the possibility of receiving a subrogation claim. If you do not, you may later find yourself forced to pay out most of the money you obtain as compensation to a third party.

The following general information should help you understand what subrogation claims are, how they work, and how a medical malpractice lawyer can help with them.

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What Are Subrogation Claims in Relation to a Health Insurance Company?

The term “subrogation” describes an insurer’s right to recover the value of the claim paid to their policyholder from the party responsible for the insured losses. The insurance carrier can seek recovery directly from the at fault party or, in some cases, from the insured.

By filing a compensation claim against the party at fault or their insurer, you already hold the party at fault responsible for their actions. Your insurance provider cannot do it again, so they may claim their losses from you.

What Does a Subrogation Claim Mean for Your Georgia Medical Malpractice Case and Medical Expenses?

If your medical bills related to the malpractice were paid by a health insurance company, Medicaid, Medicare, or a health plan, you may have to pay them back. Federal law, particularly ERISA, often governs the subrogation rights of self-funded health plans. At least, that is what Georgia code section 33-24-56.1 stipulates. You may have to reimburse your insurer for all the bills they paid or only for part of them.

Similarly, if you have unpaid medical bills for medical care services relating to the malpractice, you may have to pay them from the amount you recover. Let’s say you underwent surgery and the surgeon forgot a sponge inside.

Removing it may have required another surgery, covered by your insurance policy. Perhaps the intervention was not covered and your medical bills remained unpaid. When you seek compensation from the surgeon or the healthcare facility, your claim covers healthcare expenses as well.

State law also plays a significant role in determining the enforceability of subrogation claims. You may find yourself having to repay the value of the medical bills to the insurer or, in the second case, to the unpaid healthcare provider. The amount and the details depend on several factors, such as:

  • The insurer and their policies
  • The healthcare provider
  • Where and how the malpractice occurred
  • The value of the subrogation claim
  • The value of the compensation you obtain
  • The timely filing of the subrogation claim

Every case is different, and every insurance provider has their own rules and policies. It takes legal knowledge and experience to determine how the law applies and what subrogation claims may appear in a specific case.

Sure, a subrogation claim may considerably diminish the compensation you obtain. However, it does not mean that your efforts to seek compensation are not worth it. Besides medical bills, malpractice claims cover many more losses:

  • Lost wages
  • Lost earning ability
  • Pain and suffering
  • Loss of consortium or enjoyment, etc.

These often exceed by far medical expenses, so they totally justify the filing of a malpractice claim even when there is an existing subrogation claim. A simple consultation with an Albany medical malpractice lawyer can clarify that.

It will provide a realistic evaluation of the case and estimate the impact of a potential subrogation claim. It will also give you the chance to ask questions, receive answers and advice, and make an informed decision. Since some lawyers provide such consultations for free, you have no reason not to schedule one.

How Subrogation Works in Malpractice Cases

When a patient files a medical malpractice case, they typically seek compensation for various damages, including medical expenses, lost wages, pain and suffering, and other related costs. If the patient’s health insurance has covered their medical expenses, the insurance company, or insurance carriers, have the right to recover those costs from the amount awarded to the patient through the lawsuit. This process is known as subrogation. The insurer effectively steps into the shoes of the insured to claim a portion of the settlement that corresponds to the medical expenses they paid.

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Schedule a Free Review of Your Medical Malpractice Case with One of Albany’s Most Reputed Lawyers!

At Joe Durham Jr. P.C., we have handled hundreds of medical malpractice cases. We know all about subrogation claims and how they impact cases like yours. We can easily assess their value to help our clients have realistic expectations from their cases. Whether you are only preparing for what may follow or you have already received the subrogation claim, we can help.

Our Albany medical malpractice lawyer will review your case details, including any subrogation claims from your health insurer and documents from the plan administrator, and provide all the information and advice you need. If you allow us, we will take over all formalities and get you the compensation you deserve, high enough to cover the value of any subrogation claim, any losses you incurred, and still be worth the trouble. Schedule your free consultation now, to start benefitting from our help as soon as possible!

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