When a dog attack disrupts your life, if you have medical insurance, medical bills are usually sent to your health insurance provider. This is because when it comes to billing, hospitals work directly with your health insurance provider, instead the dog owner.
Once billed, your health insurance company then evaluates the accident, the injuries, procedures performed, and all the costs associated with the injury. Because a dog bite is often an injury associated with negligence from a neighbor or stranger (a “third-party”) who could have made a better decision to prevent the bite from happening in the first place, your health insurance carrier may have a lien to recover its treatment costs from that third-party.
Insurance companies don’t like to pay for things if they don’t have to, and treatment for a bite from a dog is something they’re thinking is a bill they can get someone else to cover.
This does not mean the insurance company will not pay your medical bills. In the aftermath of an accident or a dog mauling, your insurance company will often pay your medical bills – since you pay for that coverage making you a paying customer – but the insurer may have a lien against any money you recover from the third-party.
What Happens When Dog Bite Settlement Covers the Medical Costs?
If an investigation, or legal claim takes place making dog owners and their insurance pay, and money is recovered, your health insurance may want to be reimbursed. This does not mean the money must be sent off to your health insurance provider…. Not all insurance plans are entitled to be reimbursed! (a process called subrogation in legal circles).
However, even though they are not entitled to the money, some insurance companies may try to collect, anyway. If you’re not familiar with Georgia’s laws and Federal Laws controlling health care reimbursement, you could end up paying out much of what you recovered in your settlement.
What is ERISA and will it Apply to Me After a Dog Bite?
In certain dog bite cases where negligence from a third party took place your insurance company must comply with Federal laws. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that regulates some (but not all) health plans in private industry. Health Insurance Plans that are controlled by ERISA often have a strong right to be reimbursed from your settlement or award, often they are able to recover a high percentage of the medical costs.
This does not mean that ERISA-based health insurance companies are automatically entitled to a dollar-for-dollar reimbursement. Our firm regularly negotiates with ERISA insurance plans to significantly reduce the amount paid back to the health insurance company for dog bites. Each dollar not paid back is another dollar you get to keep. Be advised, however, that ERISA carriers are notoriously tight-fisted and may not relent or reduce your dog bite lien without some very tough negotiation.
Is It Possible to Avoid Repayment to a Health Insurance Company?
In the State of Georgia, certain Non-ERISA health care plans and providers have very limited rights (or no right whatsoever) to seek reimbursement from you after a dog bite settlement or verdict unless they can prove you were “made whole.”
Put in simple terms, the “made whole’ rule in Georgia is such that only after you’ve been fully compensated for your losses can you be considered “made whole.”
Because dog bites come with lifelong physical and emotional scars, and sometimes lifelong disabilities, and because most settlements involve a compromise, it is doubtful that any normal person has been “made whole” (as the term is legally defined under Georgia law) by their settlement.
Most dog bite victims are not made entirely “whole,” by their settlement, but because they don’t understand this rule, many end up paying back medical expenses anyway. This is where it helps to have a good lawyer. As you might imagine, insurance companies don’t usually spend much time telling you that you might not owe them anything – they just take the money and run.
Are powerful medical liens under ERISA, Medicare, and Medicaid negotiable?
Yes. Part of the subrogation equation is that health insurance plans written under ERISA or governed by Medicare and Medicaid are not necessarily entitled to dollar-for-dollar reimbursement for your post-bite settlement. This means that if you are required to reimburse, your attorney can negotiate how much you will pay. This can result in significant savings.
- Review your Health Insurance Plan – In order to avoid any confusion about whether or not you owe reimbursement payment to your health insurance company, you’ll be wise to allow your attorney to review your policy early on. By knowing the details of what to expect, your attorney can protect you from unhappy surprises in the end.
- Understand the “Made Whole” Doctrine – Knowing what laws apply to your health insurance plan will determine what you might owe in subrogation. A lawyer who specializes in personal injury cases works with Georgia’s “made whole doctrine” every day can potentially help you save thousands of dollars.
- Negotiate Like a Boss – Approaching and overcoming tough negotiations may be the subject of many how-to books, but in order to do it successfully, you must know the laws that control subrogation and practice your skills like an athlete. Lawyers who face tough negotiations all day every day tend to get very good at it.
At the Millar Law Firm, one of our main goals is to help you keep more of your settlement. We do this by
- Reviewing each insurance plan and limiting the health insurer’s reimbursement strictly to the amount to which it is legally entitled and no more.
- Eliminating the health insurance company’s claim completely (generally under the Georgia “made whole doctrine”) whenever possible.
- Allowing you to move on with your life from the violent dog attack with the peace and security you deserve.
We fight hard to help you keep your settlement. If you would like to know whether – after a dog bite or any other injury – you must pay part of your settlement or recovery to a health insurance plan, call us today for a free consultation. 740-400-0000.