Georgia's made-whole rule (O.C.G.A. § 33-24-56.1) lets a health insurer recover from your injury settlement only if the recovery exceeds all your economic and noneconomic losses, reduced by a share of attorney's fees. Self-funded ERISA employer plans generally aren't bound by that state rule. Georgia Medicaid has a lien for what it paid (§ 49-4-149), limited to the medical portion of a recovery. Medicare must be repaid under federal law.
Health coverage keeps treatment going after a crash, but it often comes with strings. Most plans include a reimbursement or subrogation clause, and public programs have statutory repayment rights. Which rule applies depends on who paid: a private insurer, your employer's self-funded plan, Medicaid, or Medicare. Getting this right can make a large difference in what you actually take home.
Private health insurance: Georgia's made-whole rule
Under O.C.G.A. § 33-24-56.1, a health insurer or other benefit provider that paid injury-related medical or disability benefits can be reimbursed from your personal injury recovery only if "the amount of the recovery exceeds the sum of all economic and noneconomic losses incurred as a result of the injury." If the settlement "does not fully and completely compensate the injured party," there's no reimbursement.
- Even when reimbursement is allowed, it's capped at the benefits paid and reduced by the pro rata share of attorney's fees and litigation expenses.
- The benefit provider can't sue the at-fault person directly; subrogation against the at-fault party "is prohibited."
- The claimant must notify the benefit provider by certified mail or statutory overnight delivery at least 10 days before settlement or trial. Your lawyer handles this.
- The rule doesn't apply to Medicaid recovery by the Department of Community Health, or to workers' compensation subrogation.
The big exception: self-funded ERISA plans
Many large employers pay employee health claims out of their own funds rather than buying an insurance policy, even if a well-known insurer administers the plan. Under the U.S. Supreme Court's decision in FMC Corp. v. Holliday (1990), self-funded ERISA plans are exempt from state laws that regulate insurance. As a result, Georgia's made-whole rule generally doesn't bind them, and the plan's own terms control. Insured employer plans remain subject to state insurance law through their insurers.
Finding out whether your plan is insured or self-funded is one of the first things your lawyer will do. Ask your HR department for the plan's Summary Plan Description.
Georgia Medicaid
- The Department of Community Health has a lien for the charges for medical care it provided, against the recipient's recovery from a third party (O.C.G.A. § 49-4-149). It has one year from the date of the last item of care to file, and the lien doesn't affect the priority of the attorney's lien.
- Federal law limits how much Medicaid can take. In Arkansas DHHS v. Ahlborn (2006), the U.S. Supreme Court held a state can't recover more than the portion of the settlement representing medical expenses. In Wos v. E.M.A. (2013), it rejected a one-size-fits-all statutory allocation.
- In Gallardo v. Marstiller (2022), the Court held that a state may seek reimbursement from settlement amounts allocated to future medical care, not just past care. That expanded Medicaid's recovery, though it's still limited to medical damages.
Medicare
Medicare is a "secondary payer" when liability insurance is responsible for an injury. Under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2), payments Medicare makes are "conditioned on reimbursement" when a settlement or judgment comes in. The federal government has subrogation rights and can recover double damages from parties that fail to reimburse. Medicare's claim isn't subject to Georgia's made-whole rule or the Ahlborn limits.
Because of those stakes, liability insurers usually insist that Medicare's claim be resolved as part of the settlement. Expect your lawyer to request Medicare's conditional payment information early and to review it for unrelated charges.
Hospitals and providers
Separately, hospitals and some providers can file liens directly against your claim under Georgia law, usually when they haven't been paid by insurance. See hospital liens in Georgia.
What to do
- Tell your lawyer every source that paid medical bills: private insurance, an employer plan, Medicaid, Medicare, MedPay, VA, or TRICARE.
- Keep explanation of benefits (EOB) statements and letters from any plan or recovery vendor. Don't sign reimbursement agreements without advice.
- Expect the settlement closing statement to show each lien paid. See how contingency fees work.
- For injuries after April 21, 2025, health insurance payments also affect how medical damages are proven. See medical bills after 2025.
Frequently Asked Questions
Does my health insurance get paid back from my settlement in Georgia?
Under Georgia's made-whole rule, a health insurer can be reimbursed only if your recovery exceeds all your economic and noneconomic losses, and its claim is reduced by a share of attorney's fees. Self-funded ERISA employer plans generally aren't bound by that rule, and Medicaid and Medicare have their own repayment rights.
What is the made-whole doctrine in Georgia?
It's the rule in O.C.G.A. § 33-24-56.1 that a health insurer or benefit provider can't be reimbursed from an injury recovery unless the injured person has been fully compensated for all losses.
Can Medicaid take my whole settlement?
No. Federal law limits Medicaid's recovery to the medical portion of the settlement. Since Gallardo (2022), that can include amounts allocated to future medical care.
Do I have to pay Medicare back after an injury settlement?
Yes. Under the Medicare Secondary Payer Act, Medicare's conditional payments must be reimbursed from a liability settlement. Your lawyer can request Medicare's claim information and dispute unrelated charges.
Sources
This guide is general information about Georgia law as of October 29, 2026. It is not legal advice, and reading it does not create an attorney-client relationship. Laws change and every case turns on its own facts. Talk to a lawyer about your situation before you rely on a deadline or rule described here.