Will My Award Be Affected if My Insurance Covers Part of My Costs?

In some states, insurance companies cannot recover any amount unless the injury victim recovers economic and non-economic damages. For instance, in Georgia, insurance companies cannot claim part of the settlement amount if the injured individual has not attained the kind of settlement that would make them feel 'whole.' In other words, for the insurance company to claim anything from the settlement amount, the insured must be put back in the position they were before the injury.

The exact amount your insurance company may be able to recover will depend on many different factors. In most cases, an experienced personal injury attorney can negotiate with the insurance company on your behalf to ensure they do not charge you more than they should. In other instances, the attorney might argue against deducting any amount from your settlement. 

Insurance companies can only recover what they spent after your injury but not what you recovered for your non-economic damages. For instance, the insurer cannot recover the money you received for your pain and suffering, loss of enjoyment of life, permanent disfigurement, and other non-economic damages.

Again, this will depend on the jurisdiction. In Georgia, for example, the 'made whole' doctrine prohibits insurance companies from recovering any settlement from an injury victim if the injured individual has not recovered to the point they would have been before the accident. Therefore, if you have future medical expenses, it is unlikely that the insurance company will be able to recover the amount they paid to cover your medical expenses after the injury.

Understandably, subrogation does not make sense to many people. This is because, if you pay insurance premiums, you expect your insurance company to cover you when you get injured. This applies only if your current insurance policy covers your specific injuries. So why would your insurance company want to recover something you are already covered for?

Here's their most common argument to justify subrogation:

Because you were injured by another party and won the case, your insurance company could claim that there would not be any need to compensate you except for the other party's negligence. Therefore, subrogation allows them to recover the money “from the other party.”

This topic has always been controversial, which is why states like North Carolina prohibit subrogation in privately-funded health insurance policies because insurance companies do not play fair. However, they may allow subrogation for Federal insurance programs such as Medicare and Medicaid.

If your insurance company wants to subrogate your settlement, it is advisable to consult an experienced personal injury attorney immediately. The attorney will review the terms of your insurance policies, including both state and federal laws to determine whether the insurance company is acting illegally.

Other than checking whether the insurance provider is acting within the confines of the law, an experienced attorney can also evaluate the nature of your injuries to determine how much compensation you are entitled to. For instance, before accepting a settlement, the attorney will determine whether you will need further treatment in the future for the injuries you sustained during the accident.

On top of the medical expenses, an experienced attorney will include other factors such as the cost of transportation to and from your medical appointments, costs of medical equipment, caregiving costs, and so on.

This strategy helps limit the amount of money your insurance provider might be able to claim. As mentioned earlier, if you have other upcoming or recurring expenses relating to your injury, it may be difficult for your insurance company to claim part of your settlement.

Morgan and Morgan is the largest personal injury law firm in the country. For this reason, we have dealt with countless insurance companies and are familiar with their tactics to claim what is not rightfully theirs.

If your insurance company claims part of your settlement, they may be acting out of greed, not goodwill. In fact, their actions could be illegal depending on the jurisdiction, type of insurance, terms of your insurance policy, and other factors.

At Morgan and Morgan, we have the legal resources and experience to defend you against selfish and greedy insurance companies. Insurance companies all over the country know that Morgan and Morgan attorneys do not compromise when it comes to fighting for their client's rights.

Ready to protect what is rightfully yours? Contact us today for a free case evaluation.