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How does the Affordable Care Act affect a future settlement?

The Affordable Care Act affects the maximum award that plaintiffs in medical malpractice or other medical-related personal injury lawsuits may receive. Georgia, like several other states, restricts personal injury compensatory damages from including reimbursement for medical care paid by sources other than the plaintiff under the state’s Collateral Source Rule

This means that if your future medical care stemming from the damage of medical malpractice or misdiagnosis will be covered by your insurance, then you cannot claim the value of the insurance payments for care as part of your economic damages. Georgia Code § 51-12-1 prevents plaintiffs from being paid twice for the same service – once by their insurance coverage and a second time in the malpractice settlement.

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The Affordable Care Act’s extended coverage and malpractice settlements

Prior to the implementation of the ACA, fewer people had access to health insurance and opted to not seek medical care due to the high cost. Many medical claims were denied by insurance companies on the basis that the treatment was for a “pre-existing condition.” 

Now, however, insurance carriers may not deny a claim based on a pre-existing condition and must cover the required treatment. Many medical malpractice claims may have been denied due to a pre-existing condition but now will be covered because of the ACA. Because more people have health insurance due to the ACA, more people are seeing doctors and other medical providers which can result in an increase in medical malpractice claims. 

How the ACA can affect a future settlement

Before the ACA was enacted, many health insurance policies were governed by the policies set forth by the Employee Retirement Income Security Act (ERISA) because they were employer-sponsored plans. Per ERISA policies, health insurance carriers were permitted to be reimbursed for monies paid to and for medical malpractice plaintiffs if the plaintiff successfully recovered damages in a claim.

ERISA only applied to employer-sponsored health plans, not individually-purchased plans, so if someone didn’t participate in an employer-sponsored plan, then the insurer’s right to reimbursement didn’t apply. 

This essentially allowed the plaintiff to be doubly compensated because their medical costs were paid by their insurance, then they collected damages for the costs they incurred, including the medical costs which they didn’t pay out of pocket. 

ACA and medical malpractice claim valuation 

Your Albany medical malpractice lawyer will value your medical malpractice claim to include your out-of-pocket medical costs, including getting a second opinion for a misdiagnosis and new, more appropriate treatment for their true condition. Some patients affected by misdiagnosis may require more intensive (and expensive) treatment; for example, cancer that was not properly diagnosed in its early stages may require a more aggressive treatment now that the disease has progressed. 

This may affect how damages in a medical malpractice or personal injury claim are calculated, and it’s important to note how this could affect the value of your claim. Now, a Georgia medical malpractice claim would only be valued on the amount of a plaintiff’s out-of-pocket medical costs, not the total cost of medical treatment and aftercare. 

Limits under the ACA of certain damages that can be awarded

The lifetime dollar limits on insurance coverage were removed under the ACA, which means that a malpractice victim’s insurance coverage would extend to cover all treatments necessary to correct the damage.

Therefore, the economic damages of a settlement would not need to include paying for medical care above a policy limit – under the ACA, there’s no limit to medical coverage, so a medical malpractice attorney wouldn’t need to consider this when valuing your claim.

In Georgia, a personal injury or malpractice settlement’s medical damages should be limited to:

  • Cost of the plaintiff’s insurance premiums
  • Cost of co-pay and co-insurance fee
  • Deductible (for each year that medical treatment is expected to be needed)

It’s important to note that the ACA may affect this particular part of a settlement but may not impact the damages a plaintiff may collect for other determinable losses.

Moving forward with personal injury and medical malpractice claims

Georgia doesn’t have a cap on the non-economic damages a plaintiff may be awarded. However, an ACA-related reduction in economic damages may affect the non-economic damages award because non-economic damages are often calculated as a factor of the economic damages. If the economic damage awards are consistently reduced, then the non-economic damages may be, too.

Have you been harmed by medical malpractice? Call Shrable Law Firm today to get the help you need.

If you or someone you love were harmed by medical malpractice or misdiagnosis by a healthcare provider, you might have the right to file a medical malpractice claim against the at-fault party. 

The Albany medical malpractice lawyers at Shrable Law Firm protect victims just like you and will help you explore your legal options to hold negligent doctors accountable. Contact us today at (229) 349-6291 for a free case evaluation.

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