The Georgia Made Whole Doctrine Explained

If you are injured in an accident and pursuing compensation, you may encounter the “made whole doctrine” legal principle. This doctrine determines how damages are allocated when multiple sources of recovery exist. You should also know how it can impact your case and how an Atlanta personal injury lawyer can help protect you under this doctrine.

What Is the Made Whole Doctrine?

The Georgia Made Whole doctrine is a legal rule that states an injured plaintiff must receive compensation for all losses. This included all losses before any third parties could seek repayment of what they already covered. In most states, this doctrine is applied to preserve the priority of compensating the victim first.

For example, if your health insurer pays some of your medical bills or other damages after an accident, the at-fault party cannot seek reimbursement until you have been fully “made whole”. This means it must be through total compensation for all your losses. The plaintiff must recover funds for the full spectrum of damages before the insurer can collect repayment for what they initially covered.

This doctrine protects the rights of injured individuals whose losses exceed what initial payments from insurers or other sources covered. It prevents third parties like insurance companies from prioritizing their reimbursement over the plaintiff’s right to be fully made whole first. Without the made whole doctrine, victims could end up undercompensated even after a settlement or court award.

The Made Whole Doctrine in Georgia

Georgia has codified the made whole doctrine in statute O.C.G.A. §33-24-56.1. This law applies broadly to all health insurers, disability plan, PPOs, HMOs, healthcare provider, or lost wage provider that provides insurance to a group or individual in the state. The key points explain that insurance entities cannot seek reimbursement from a plaintiff’s recovery unless the injured individual is fully compensated for their losses.

This can be calculated by subtracting the reimbursement amount, attorney fees, and legal expenses from the total recovery. If the remaining amount of the plaintiff is less than the proven value of damages, technically, the individual was not “made whole.” If this is the case, the plaintiff is not obligated under this Georgia law to reimburse the insurer.

This statute shows Georgia’s commitment to prioritizing plaintiffs’ complete compensation over insurance companies’ financial interests. The codification into law strengthens the made whole doctrine compared to states relying solely on common law precedent. However, insurers may still try to circumvent the spirit of the law by contractual provisions, so experienced legal advocacy is key.

Subrogation Is Affected

A typical application involves insurance subrogation clauses. These provisions allow insurers to seek repayment from liable third parties after covering their insured’s losses. However, subrogation cannot be exercised in Georgia until the insured is made whole.

For example, if your health insurer paid $25,000 in medical bills after a car accident, but your total losses were $100,000, the at-fault party must not reimburse your insurer anything until the additional $75,000 losses have been paid to you. Only then can subrogation apply. Having an attorney well-versed in the made whole doctrine is key to ensuring priority of your full compensation.

Your plaintiff will be aware of insurers that may still try to undermine the made whole doctrine. They do this through misleading communications and imply that subrogation takes priority. Carefully reviewing policies and understanding your rights under Georgia law provides protection.

Applies to All Damages Claimed

For the made whole doctrine to apply, the plaintiff must demonstrate that claimed losses are legitimate and accurately quantified. Plaintiffs must account for every category of damages sought. The categories to keep in mind for this is:

• Medical expenses
• Lost wages
• Property losses
• Pain and suffering
• Loss of enjoyment of life
• Disability and disfigurement
• Emotional distress

Only when every claimed loss is proven and fully compensated can third parties seek repayment of amounts they covered. Thorough evidence and accounting are necessary to show the total losses warranting compensation under the made whole doctrine. An attorney can help demonstrate all categories of damages through documentation, expert testimony, and compelling presentation.

Burden of Proof Is Key

The made whole doctrine places the burden of proof on the plaintiff seeking damages, not the subrogated insurer. Plaintiffs must show the court that claimed losses accurately represent being made whole. The court cannot find the plaintiff to be made whole if the evidence is inconclusive or speculative regarding the full losses.

The benefit of the doubt goes to the defendants. This heightened burden aims to protect defendants and the integrity of the courts, ensuring plaintiffs cannot recover more than their actual losses. However, plaintiffs face challenges quantifying non-economic and future losses. This can lead to potential disputes over the evidence.

Defendants may argue that plaintiffs fail to prove full losses. They do this while plaintiffs maintain difficulties in capturing the extent of the harm suffered. The made whole doctrine underscores how plaintiffs must thoroughly prove their case without relying on speculation or assumptions.

Impact on Settlements and Trial

The made whole doctrine affects pretrial settlement negotiations. Defendants need to satisfy all plaintiff losses before funds can be allocated elsewhere. This motivates resolving the full claim in settlement talks.

For example, suppose a plaintiff’s proven medical damages are $50,000. However, their health insurer previously paid $20,000. In that case, the defendant must offer at least $30,000 in settlement for the plaintiff to be made whole before the insurer can collect on subrogation.

If unsettled, the plaintiff must establish at trial they have not already been fully compensated from other sources. Their attorney must explain that prior health insurance payments or additional funds received covered only part of the losses. Juries cannot duplicate previous payouts in their award.

Consult a Personal Injury Lawyer in Georgia to Protect Your Rights

While you carry the burden of proving a total loss, quantifying non-economic damages is challenging without the proper knowledge. If your insurance company demands subrogation before you are made whole or a defendant disputes your evidence, it is likely time to act. You deserve a fair chance.

Our team is ready to help you fight for your rights. You deserve to be fully compensated under the made whole doctrine. Contact a Georgia personal injury lawyer on our team for a free consultation.