When dealing with insurance regulations, it is a rare scenario to find a law that actually appears designed to help the insured and not the insurer. The notice provisions or "10 day rule" found in Georgia Code Section 33-24-56.1 is one of those exceptions.
Here's where to find it.
The code section, 33-24-56.1, is referred to as Georgia's "anti-subrogation statute." Per the statute, an insurer's right to seek reimbursement for benefits paid is allowed only in cases where the insured's recovery proceeds are greater than all economic and non-economic losses, exclusive of losses for which reimbursement is sought. This is commonly referred to as the "Made Whole Doctrine," or "Full Compensation Rule." Basically, it means there is only a right to reimbursement by the state-regulated insurer whenever the plaintiff's recovery proceeds are greater than the damages, even after those proceeds are reduced by the reimbursement claim.
The code section also contains a strict notice provision in 56.1(g) that can prevent insurers from being able to argue the client was made whole. This is the "10-Day Rule."
Under the 56.1(g) notice provision, an attorney can request an itemized list of payments from the insurer showing the payments for which it is seeking reimbursement. The regulation says this should be sent at least 10 days prior to settlement or trial, and -- most importantly -- by certified mail or statutory overnight delivery.
Should the attorney send this via certified mail and follow the other specifications, there is a reciprocal notice requirement in 56.1(h) for the insurer to follow. Per the statute, the insurer must respond with its itemized list of payments -- also via certified mail or overnight delivery -- prior to settlement or trial. If the insurer fails to respond by certified mail prior to settlement or trial (such as faxing the ledger at the last minute) the insurer is in violation of the statute.
This failure to properly respond per the statute allows the plaintiff attorney to argue the insurer is cut off from being able to argue the patient was made whole, and therefore no right to reimbursement exists.
Even if the insurer does successfully comply with the statute, there is no guaranteed right to reimbursement. The insurer still has the burden of showing the client is made whole, and the reimbursement must be reduced by the attorneys fees and expenses, per the statute.
Ben Price is a partner at the law firm of Jarrett & Price in Savannah, Georgia. The information on this site is intended for Plaintiff's lawyers only. The content on this site does not establish an attorney-client relationship and in no way should be considered legal advice.
Here's where to find it.
The code section, 33-24-56.1, is referred to as Georgia's "anti-subrogation statute." Per the statute, an insurer's right to seek reimbursement for benefits paid is allowed only in cases where the insured's recovery proceeds are greater than all economic and non-economic losses, exclusive of losses for which reimbursement is sought. This is commonly referred to as the "Made Whole Doctrine," or "Full Compensation Rule." Basically, it means there is only a right to reimbursement by the state-regulated insurer whenever the plaintiff's recovery proceeds are greater than the damages, even after those proceeds are reduced by the reimbursement claim.
The code section also contains a strict notice provision in 56.1(g) that can prevent insurers from being able to argue the client was made whole. This is the "10-Day Rule."
Under the 56.1(g) notice provision, an attorney can request an itemized list of payments from the insurer showing the payments for which it is seeking reimbursement. The regulation says this should be sent at least 10 days prior to settlement or trial, and -- most importantly -- by certified mail or statutory overnight delivery.
Should the attorney send this via certified mail and follow the other specifications, there is a reciprocal notice requirement in 56.1(h) for the insurer to follow. Per the statute, the insurer must respond with its itemized list of payments -- also via certified mail or overnight delivery -- prior to settlement or trial. If the insurer fails to respond by certified mail prior to settlement or trial (such as faxing the ledger at the last minute) the insurer is in violation of the statute.
This failure to properly respond per the statute allows the plaintiff attorney to argue the insurer is cut off from being able to argue the patient was made whole, and therefore no right to reimbursement exists.
Even if the insurer does successfully comply with the statute, there is no guaranteed right to reimbursement. The insurer still has the burden of showing the client is made whole, and the reimbursement must be reduced by the attorneys fees and expenses, per the statute.
Ben Price is a partner at the law firm of Jarrett & Price in Savannah, Georgia. The information on this site is intended for Plaintiff's lawyers only. The content on this site does not establish an attorney-client relationship and in no way should be considered legal advice.
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