Q: Do I have to repay the heatlth insurance company with settlement received from third party - State of Georgia
I was in an auto accident that was not my fault and received a settlement check from the at fault party's insurance company. This is in the state of Georgia. Do I have to pay back the health insurance company that paid some of these medical bills? It was settled without litigation.
A: It depends on the type of health plan. If you work for a large employer, they likely have a self-funded ERISA plan. This is the type of plan in which the employer pays the medical benefits, but the plan is often administered by a health insurer such as United Healthcare or Blue Cross. Under this type of plan, they have a strong legal right to seek reimbursement as the law stands right now. However, if you have a health insurance policy issued by a health insurance company which is not self-funded, then you have to be fully compensated for your economic losses and your pain and suffering before they can get reimbursement. Since settlements are generally a compromise, seldom is there an obligation to reimburse the health insuranc company under these types of policies. You need to review the health plan to determine how it is funded and the type of plan. These answers can also vary based upon the language of the plan itself.
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