Can Health Insurance Be Used Against You in a Georgia Injury Case?

It can, if you were hurt on or after April 21, 2025. Under a 2025 Georgia law, a jury can now see two numbers for your medical care: what your doctors and hospital billed, and what your health insurance would actually pay for those bills. That's true even if you never used your insurance. If you were hurt before that date, the older rules generally still apply.

Lawyers call this area the collateral source rule. It used to keep most insurance payments away from the jury. SB 68, Georgia's 2025 tort reform law, changed that for medical bills in a new Code section, O.C.G.A. § 51-12-1.1.

Having insurance does not automatically lower your medical damages to the insurance amount. The jury still decides what your medical care was reasonably worth.

Key Takeaways

• The new rule generally applies to injury claims that arose on or after April 21, 2025.
• If you have health insurance, the jury can see the billed amount and what your plan's contract would pay, even if you never used the plan.
• Neither number is automatically the award. The jury decides what your care was reasonably worth.
• If you treated under a letter of protection, those records can be requested.
• Whether your health plan gets paid back is a separate question under a different law.

Table of Contents

Which Rule Applies to You? Start With Your Injury Date

What matters is when your injury claim arose. For most injury claims, that is generally the date you were hurt, not the date you file a lawsuit.

Lawyers call an injury claim a "cause of action." SB 68 applies the new section "only with respect to causes of action arising on or after" April 21, 2025, the day Governor Kemp signed it. Older claims "shall be governed by prior law."

Example	What happens
Accident on March 15, 2025	Generally governed by prior medical-expense rules
Accident on June 10, 2025	New SB 68 medical-expense rules generally apply
Accident in 2024, lawsuit filed in 2026	Filing later does not itself make the new rule apply

These are simplified examples. The exact date that counts can differ in some cases, so talk with a lawyer about yours.

Filing Later Doesn't Change the Date

In a discovery dispute from a January 2022 car accident case, the Georgia Court of Appeals said the new letter-of-protection rule "does not apply to this case," even though it ruled after the law took effect. (Omni Healthcare, LLC v. Stacy Young Excavation, Inc., Nos. A25A1411 and others, Sept. 30, 2025.)

What the Jury Can Now See About Your Medical Bills

The new law limits medical damages to "the reasonable value of medically necessary care, treatment, or services," and the jury decides that amount. (O.C.G.A. § 51-12-1.1(b).)

If you have health insurance, the evidence of that value includes "both the amounts charged" and "the amounts actually necessary to satisfy such charges pursuant to the insurance contract." The same goes for government workers' compensation benefits. (§ 51-12-1.1(c).)

Billed Amount vs. What Your Plan's Contract Would Pay

The "billed amount" is the full price on your bills. Health plans often have contracts that set a lower price. The jury can now hear both.

Hypothetical, for illustration only.

What the jury may see	Example amount
Amount your providers billed	$40,000
Amount your health plan's contract would pay	$15,000
Who decides what your care was reasonably worth	The jury

Even If You Didn't Use Your Insurance

The plan's contract amount can come in "regardless of whether the health insurance has been used, is used, or will be used" to pay the bills. So even if you never sent your bills to your plan, the jury may hear what it would have paid.

The Jury Still Decides What Your Care Was Reasonably Worth

Neither number is automatically the award. Both sides can challenge whether the charges were reasonable and the treatment was medically necessary, and the jury decides. (§ 51-12-1.1(b) and (f).)

The Judge Can Explain Insurance to the Jury

The law changes the collateral source rule only "to the extent necessary" to let this evidence in. The judge can still give "appropriate jury instructions" to prevent confusion about insurance payments. (§ 51-12-1.1(e).)

If You Treated Under a Letter of Protection

A "letter of protection" is an agreement where a doctor treats you now and waits to be paid from your settlement or court award. For claims under the new law, the other side can ask for:

• A copy of the letter of protection.
• All charges, itemized and coded.
• If the provider sold your account for less than the bill, the buyer's name and what it paid.
• Whether someone referred you for treatment under a letter of protection, and if so, who.

Treating this way is not wrong, but these records may become part of your case. (§ 51-12-1.1(d).) Our article on medical bills and lien issues explains provider liens.

If You Don't Have Health Insurance

If you don't have health insurance, the part of the law about insurance amounts doesn't apply to you by its terms. But the law still limits medical damages to the "reasonable value" of care that was medically necessary, and the jury decides that amount.

Both sides can offer evidence about whether the charges were reasonable and the treatment was necessary. If you treated under a letter of protection, those records can also be requested.

Will Your Health Plan Want to Be Paid Back?

"Reimbursement" means paying your health plan back out of the money you recover. A different Georgia law, O.C.G.A. § 33-24-56.1, covers this for many plans.

Question	What it means for you
What can the jury hear about my insurance?	For claims arising on or after April 21, 2025, the jury can see billed and plan contract amounts (O.C.G.A. § 51-12-1.1).
Does my health plan get paid back from my recovery?	It depends on your plan type. Georgia limits payback for many private plans (O.C.G.A. § 33-24-56.1).

For plans this law covers, payback is allowed only if your recovery is more than all of your losses, including bills, lost pay, and pain and suffering. This is often called the "made-whole rule." The plan's claim is also reduced by a share of your attorney's fees and expenses. These plans also cannot go after the person who hurt you, which lawyers call "subrogation." See who pays medical bills before a claim settles.

Plans That Follow Different Payback Rules

Plan type	What it generally means
Fully insured private plan (bought from an insurer)	Georgia generally allows your health insurer to be paid back only if your recovery fully covers all your losses, and its claim is reduced by a share of attorney's fees.
Self-funded employer plan	If your plan is self-funded by your employer, federal law may let it enforce its own payback terms, and Georgia's made-whole rule may not apply.
Federal employee plan	Federal employee health plans follow federal payback rules, not Georgia's.
Medicare	Medicare must be repaid from an injury recovery under federal law, so its claim needs to be dealt with as part of any settlement.
Georgia Medicaid	Georgia Medicaid has its own lien on injury recoveries, and Georgia's made-whole rule doesn't apply to it.
Military health system or VA care	If the military health system or VA paid for care, the federal government may have its own right to recover.
Workers' compensation	If you were hurt on the job, the workers' comp insurer may have a lien, but generally only if your total recovery fully compensates you.

A lien is a legal right to be paid from your recovery.

Sources: O.C.G.A. §§ 33-24-56.1, 49-4-149 and 34-9-11.1; 29 U.S.C. § 1144; 5 U.S.C. § 8902(m)(1); 42 U.S.C. §§ 1395y(b)(2) and 2651.

Whether your plan gets paid back depends on what kind of plan it is. Check your plan documents, and talk with us before you settle.

The First Reported Jury Test: A Fulton County Verdict Against Aldi

In November 2026, the Daily Report reported what one lawyer called the first "stress test" of this law. In a slip-and-fall trial in the State Court of Fulton County, Aldi introduced evidence of the injured shopper's health insurance payments and deductible under the new rule, even though she had dropped her claim for medical expenses. The jury returned a $2 million verdict against Aldi. A single trial verdict does not set precedent, and the publicly available part of the report does not explain the court's legal reasoning. How Georgia courts apply this part of the law is still developing.

What This Change Does Not Do

• It does not cap medical damages. The new section sets no dollar limit.
• It does not apply to pain and suffering. A separate SB 68 rule limits how lawyers may argue pain and suffering amounts, and that rule generally applies to cases that were pending when the law took effect.
• It does not decide whether your plan gets paid back. That is a different law with its own rules.

What to Do Now If You Have Health Insurance and an Injury Claim

A quick check:

1. When were you hurt? On or after April 21, 2025, the new rule generally applies.
2. Do you have any health insurance? If so, the jury may see your plan's contract amounts.
3. Did you treat under a letter of protection? If so, those records can be requested.
4. Has your plan asked to be paid back? The answer depends on your plan type.

Keep these documents:

• Itemized bills from every provider, with billing codes.
• Explanation of Benefits forms (EOBs), which show what your plan was billed and paid.
• Your plan documents, including any payback terms.
• Medical payments coverage (MedPay) records from your auto policy.
• Any letter of protection, and who referred you.
• Letters from your health plan about being paid back.

How We Handle Medical-Expense Proof Under the New Rule

When you work with SinghToro Law, we start by reviewing when your injury occurred. This helps us determine whether Georgia's new SB 68 medical-expense rules may apply to your case.

We then review your medical expenses, including itemized bills, health insurance statements, and records showing what your providers charged and what your insurance paid or agreed to pay.

We also check whether your health insurer, Medicare, Medicaid, or another benefit provider may have a right to reimbursement from your recovery. If you received treatment under a letter of protection, we review those arrangements and the related records.

Our goal is to understand the full picture of your medical expenses, evaluate the reasonable value of your treatment, and identify potential reimbursement obligations before your case is resolved.

Frequently Asked Questions

Will the jury know I have health insurance?

If your injury claim arose on or after April 21, 2025, the jury may see what your health plan's contract would pay, along with the billed amount, even if you never used the plan. The jury then decides what your care was reasonably worth.

Does health insurance lower my Georgia injury settlement?

This rule is about what a jury may hear at trial. Insurance companies often consider what a jury is likely to hear when they make settlement offers, so it can come up in settlement talks too. The rule itself sets no automatic reduction.

My accident was in early 2025. Does SB 68 apply?

If you were hurt before April 21, 2025, prior law generally governs your medical expenses, even if you file suit later. The exact date that counts can differ in some cases, so talk with a lawyer about yours.

Does this apply to Medicare or Medicaid?

The law covers "any form of public or private health insurance." That may include government health coverage such as Medicare or Medicaid, but Georgia's appeals courts have not yet ruled on how this part of the law applies to those programs. If you have Medicare, Medicaid, TRICARE, VA care or another government plan, talk with us about how the rule may apply to you. Medicare and Medicaid also have their own payback rules.

Does this change apply to car accidents and slip-and-falls alike?

Yes. The new section covers "any civil action to recover damages resulting from injury or death to a person." That includes car accident claims, slip-and-fall claims and other injury cases that arose on or after April 21, 2025.

Talk With Us About Your Medical Bills

Questions about health insurance, medical bills, or a plan asking to be paid back? We can review your injury date and plan type in a free consultation. Our office is at 1954 Airport Rd, Suite 103, Chamblee, GA 30341. Call 844-785-5291 or contact us online.

No Fee Unless We Win. You pay no attorney fee unless we recover compensation for you.

This article gives general information about Georgia law and is not legal advice. Reading it does not create an attorney-client relationship. SB 68 is recent, and courts are still working out how it applies.