What is Subrogation or right of reimbursement?

Subrogation or right of reimbursement, is the right that most insurance companies hold that allows them to legally pursue reimbursement for money they have paid out on their insured’s behalf.  What does all of that mean? It means the insurance company seeking subrogation (i.e. health insurance, Medicare, Medicaid or workers’ compensation insurance) can go after the insured for money that was paid out for car accidents, a slip and fall or a personal injury type of case in certain circumstances.  The insurance company that is seeking subrogation/reimbursement can intervene in any litigation you may have in an effort to be reimbursed for money they paid out.  However, the right is not guaranteed.  This is a complex set of laws and not something you should attempt to fight on your own.  It is important to retain an attorney who has experience in dealing with subrogation/right of reimbursement issues.  Insurance companies can take you to court to

When can a subrogation come into play? 

Let’s use an example.  Sally and Dan are in a car accident.  The police accident report is not clear on who is at fault for the accident.  It cites each with a failure to yield.  Dan is injured and uses his health insurance to pay for the medical care.  Dan does not hire an attorney.  He is working directly with his insurance company thinking that they will take care of everything because that’s what he “pays them to do”.  

At some point during the case, it is determined that Sally was actually the “at fault” driver.  Dan’s health insurance company wants to get their money back from any recovery Dan receives from Sally’s insurance company for the money they have paid out for Dan’s medical bills.  This is called “subrogation or right of reimbursement”.  

Dan’s situation just got complicated because Dan does not know how much more physical therapy he will need to improve the mobility of his arm.  His doctors have said there is a possibility of shoulder surgery.  Because Sally is at fault, Dan’s health insurance has notified him of their right of reimbursement/subrogation and to NOT settle the case until Dan speaks with his health insurance company on how much he owes them before he receives any money from a settlement.  

What should Dan do next? 

Dan should hire an experience personal injury lawyer who knows the Georgia law.  This case is probably going to continue to become more and more complicated as the insurance companies try to determine payouts for past and future bills.  At this point, Dan could be on the hook for money he has received so having an attorney represent him will provide him with an advocate to help him understand the situation and fight for his rights.  

Contact Us

As you can see the issue of subrogation or right of reimbursement is complex. If you find yourself in Dan’s position, contact us. Ty has the experience to handle complex situations like the one above so that you can stay out of the middle and focus on your healing.