(a) As used in this Code section, the term: (1) "Benefit provider" means any insurer, health maintenance
organization, health benefit plan, preferred provider
organization, employee benefit plan, or other entity which
provides for payment or reimbursement of health care expenses,
health care services, disability payments, lost wage payments, or
any other benefits under a policy of insurance or contract with an
individual or group. (2) "Injured party" means a person who alleges that he or she has
been injured by the acts or omissions of a third party and who has
received benefits from a benefit provider. This term also
includes the personal representative of the estate of such person. (b) In the event of recovery for personal injury from a third party
by or on behalf of a person for whom any benefit provider has paid
medical expenses or disability benefits, the benefit provider for
the person injured may require reimbursement from the injured party
of benefits it has paid on account of the injury, up to the amount
allocated to those categories of damages in the settlement documents
or judgment, if: (1) The amount of the recovery exceeds the sum of all economic and
noneconomic losses incurred as a result of the injury, exclusive
of losses for which reimbursement may be sought under this Code
section; and (2) The amount of the reimbursement claim is reduced by the pro
rata amount of the attorney's fees and expenses of litigation
incurred by the injured party in bringing the claim. (c) In the settlement of any claim for personal injury, under circumstances where it is claimed that the amount of the recovery does not exceed the sum of all economic and noneconomic losses incurred as a result of the injury, a benefit provider which has paid benefits to or on behalf of the injured person may seek a declaratory judgment pursuant to Code Section 9-4-2 as to what extent it may equitably share in said settlement. If the court determines said settlement does not fully and completely compensate the injured party, the benefit provider has no right of reimbursement. (d) In the trial of any case for personal injury submitted to a
court or jury, the trier of fact may allocate the amounts paid among
the categories of damages actually sought by the plaintiff at trial,
and it shall be conclusively presumed that such allocation by the
trier of fact is reasonable. (e) Subrogation for medical expenses and disability payments by a
benefit provider against a person at fault for injury is prohibited
and no defendant or liability insurance carrier shall include any
insurer seeking reimbursement under subsection (b) of this Code
section as a copayee on any check or draft in payment of a
settlement or judgment. (f) No benefit provider shall be entitled to reduce the amount for
which it is liable under an insured party's coverage for liability,
uninsured motorist, disability, medical payments, or other benefits
as a setoff against any claim for reimbursement under subsection (b)
of this Code section, nor shall any benefit provider be entitled to
withhold or set off insurance benefits as a means of enforcing a
claim for reimbursement. Nothing in this subsection shall be deemed
to prohibit the coordination of benefits between or among benefit
providers. (g) When a recovery for personal injury is sought from a third party
by or on behalf of a person for whom any benefit provider has paid
medical expenses or disability benefits, the person asserting the
claim for recovery against the third party shall provide notice of
the existence of the claim, by certified mail or statutory overnight
delivery unless some other form of notice is agreed to by the
designated recipient of the notice, to any benefit provider which
the person asserting the claim has reason to believe has paid
benefits relating to the injury for which the injured party seeks a
recovery. This notice shall be provided no later than ten days
prior to the consummation of any settlement or commencement of any
trial unless a shorter notice period is agreed to by the designated
recipient of the notice and shall include a request for information
regarding the existence of any claim by a benefit provider and an
itemization of payments for which the benefit provider seeks
reimbursement including the names of payees, the dates of service or
payment or both, and the amounts thereof. (h) If the notice required in subsection (g) of this Code section is
provided, a claim for reimbursement under subsection (b) of this
Code section is enforceable against an injured party only to the
extent that such person has actual notice prior to the consummation
of a settlement or commencement of trial, by certified mail or
statutory overnight delivery or other form of notice if agreed to by
the designated recipient of the notice, of the claim of the benefit
provider for reimbursement including a specific itemization of
payments for which the benefit provider seeks reimbursement,
including the names of payees, the dates of service or payment or
both, and the amounts thereof. Nothing contained in this subsection
shall prohibit the supplementation of a claim prior to the
consummation of a settlement or judgment, except that any
supplemental claims shall be subject to the notice requirements
contained in this subsection. (i) If the notice required in subsection (g) of this Code section is
not provided, then subsection (h) of this Code section shall not
apply, and a claim for reimbursement under subsection (b) of this
Code section is enforceable subject to the other provisions of this
Code section. (j) No benefit provider contracts or policies containing or
incorporating provisions in conflict with this Code section may be
issued in this state, and no policy or contract provisions for
subrogation or reimbursement in conflict with this Code section may
be enforced by a benefit provider with regard to claims or injuries. (k) Any settlement which is subject to this Code section that contains a confidentiality provision as to any terms of the settlement which are necessary to a proceeding under this Code section shall be unenforceable as to the disclosure of such required information. (l) This Code section shall not apply to the rights of the Department of Community Health to recover under Article 7 of Chapter 4 of Title 49, nor shall it affect the subrogation rights and obligations provided in Code Section 34-9-11.1. |