HB 568 - Insurance; reimbursement of medical benefits; setoffs

Georgia House of Representatives - 1995/1996 Sessions

HB 568 - Insurance; reimbursement of medical benefits; setoffs

Page Numbers - 1/ 2/ 3
Code Sections - 33-24-56
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1. Reichert  126th

House Comm: Judy / Senate Comm: / House Vote: Yeas Nays Senate Vote: Yeas Nays ---------------------------------------- House Action Senate ---------------------------------------- 2/2/95 Read 1st Time 2/3/95 Read 2nd Time ---------------------------------------- Code Sections amended:
HB 568 LC 9 8131 A BILL TO BE ENTITLED AN ACT 1- 1 To amend Article 1 of Chapter 24 of Title 33 of the Official 1- 2 Code of Georgia Annotated, relating to general provisions 1- 3 relative to insurance generally, so as to provide for 1- 4 reimbursement of medical benefits paid by insurers in cases 1- 5 in which an injured insured person has been fully 1- 6 compensated for all economic and noneconomic damages; to 1- 7 create presumptions in favor of upholding allocations in a 1- 8 settlement or judgment among categories of damages; to 1- 9 provide for reimbursement claims to be paid net of a 1-10 prorated share of attorney's fees and expenses of 1-11 litigation; to restrict setoffs for medical reimbursement in 1-12 payment of other benefits; to provide that a reimbursement 1-13 claim may not be enforced against an insured or insured's 1-14 attorney without actual notice of the claim; to repeal 1-15 conflicting laws; and for other purposes. 1-16 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: SECTION 1. 1-17 Article 1 of Chapter 24 of Title 33 of the Official Code of 1-18 Georgia Annotated, relating to general provisions relative 1-19 to insurance generally, is amended by adding at the end 1-20 thereof a new Code Section 33-24-56 to read as follows: 1-21 "33-24-56. (Index) 1-22 (a) In the event of recovery for personal injury or 1-23 wrongful death from a third party by or on behalf of a 1-24 person for whom any insurer has paid medical expenses or 1-25 disability benefits pursuant to first-party insurance 1-26 coverage, the insurer for the person injured may require 1-27 reimbursement of benefits it has paid on account of the 1-28 injury, up to the amount allocated to those categories of 1-29 damages in the settlement documents or judgment, if: 1-30 (1) The injured person has been fully and completely 1-31 compensated for all economic and noneconomic losses 1-32 incurred as a result of the injury; and -1- (Index) LC 9 8131 2- 1 (2) The amount of the reimbursement claim is reduced by 2- 2 the pro rata amount of the attorney's fees and expenses 2- 3 of litigation incurred by the injured party in bringing 2- 4 the claim and by the amount of the cost incurred by the 2- 5 injured person in obtaining the insurance coverage which 2- 6 has provided the benefits subject to reimbursement. 2- 7 (b) In the settlement of any claim for personal injury or 2- 8 wrongful death, it shall be conclusively presumed that the 2- 9 amount paid is a compromise for less than the full value 2-10 of the injury or death and that the injured person has not 2-11 been fully and completely compensated for all economic and 2-12 noneconomic losses incurred as a result of the injury. 2-13 There shall be a rebuttable presumption that any 2-14 allocation in the settlement agreement of the amounts paid 2-15 among the categories of damages which were or could have 2-16 been claimed in the settlement agreement is reasonable. In 2-17 any case for personal injury or wrongful death submitted 2-18 to a court or jury, the trier of fact may allocate the 2-19 amounts paid among the categories of damages actually 2-20 sought by the plaintiff at trial, and it shall be 2-21 conclusively presumed that such allocation by the court or 2-22 jury is reasonable. 2-23 (c) Subrogation for medical expenses and disability 2-24 payments by an insurer against a person at fault for 2-25 injury is prohibited as an unlawful assignment of a claim 2-26 for personal injury, and no defendant or liability 2-27 insurance carrier shall include any insurer seeking 2-28 reimbursement under subsection (a) of this Code section as 2-29 a copayee on any check or draft in payment of a settlement 2-30 or judgment. 2-31 (d) No insurer shall be entitled to reduce the amount for 2-32 which it is liable under an insured's coverage for 2-33 liability, uninsured motorist, disability, medical 2-34 payments, or other benefits as a setoff against any claim 2-35 for reimbursement under subsection (a) of this Code 2-36 section, nor shall any insurer be entitled to withhold or 2-37 set off insurance benefits as a means of enforcing a claim 2-38 for reimbursement. 2-39 (e) A claim for reimbursement under subsection (a) of this 2-40 Code section is enforceable against an insured or an 2-41 insured's attorney only to the extent that such person has 2-42 actual notice by certified mail of the insurer's claim for 2-43 reimbursement and the amount thereof. -2- (Index) LC 9 8131 3- 1 (f) No insurance policy containing or incorporating 3- 2 provisions in conflict with this Code section may be 3- 3 issued in this state, and no policy provision for 3- 4 subrogation or reimbursement in conflict with this Code 3- 5 section may be enforced by an insurance company with 3- 6 regard to claims or injuries arising in this state." SECTION 2. 3- 7 All laws and parts of laws in conflict with this Act are 3- 8 repealed. -3- (Index)

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