Who Pays for Lifetime Care After a Catastrophic Injury?

Who Pays for Lifetime Care After Catastrophic Injury, Georgia

Who Pays for Lifetime Care After a Catastrophic Injury in Georgia: The Short Answer

Lifetime care after a catastrophic injury is usually paid by several sources at once. Health insurance or government programs often cover some care, and a personal injury claim may cover costs those sources leave behind. The main sources are health insurance and government programs, the at-fault party’s liability insurance, uninsured or underinsured motorist coverage, and workers’ compensation for on-the-job injuries. Which of these apply depends on how the injury happened, who was responsible, and what coverage exists. For the broader picture, read our catastrophic injury guide.

Why Lifetime Care Costs Differ From Ordinary Medical Bills

Lifetime care means the medical needs that continue for years or decades after an injury. These often include surgeries, hospital readmissions, rehabilitation, therapy, medications, medical equipment, home changes, and attendant or nursing care. A single hospital stay ends. Lifetime care does not.

These costs are harder to plan for than one hospital bill. Needs can shift with age, with new complications, and with new treatment options. A plan that fits today may not fit five years from now.

Paralysis shows how this works. MedlinePlus explains that paralysis is a loss of muscle function and can result from catastrophic injuries such as spinal cord injuries or a broken neck. The Brain Trauma Foundation notes that traumatic brain injuries can range from mild to catastrophic and can lead to serious, ongoing medical needs.

Lost earning capacity is a separate category from medical costs. It deserves its own look, and our guide on lost earning capacity after a catastrophic injury covers it.

Health Insurance, Medicare, and Medicaid: What They Cover and Where They Stop

Private health insurance generally pays for covered, medically necessary care under the terms of the plan. Deductibles, copays, network rules, and plan limits all shape what it pays. Medicare can apply to people who qualify because of a disability. Medicaid depends on income and asset rules. Each program has its own coverage rules.

These programs often do not pay for every cost of catastrophic care. Common gaps include some home care, adaptive equipment, and long-term attendant services.

Georgia law limits recoverable medical expenses to the reasonable value of medically necessary care, and a judge or jury decides that amount (O.C.G.A. § 51-12-1.1). If the injured person has health insurance, the evidence includes both the amounts charged and the amounts actually needed to satisfy those charges under the insurance contract or government program. That is true whether or not the insurance was used.

Our page on Medicare and Medicaid liens after a catastrophic injury explains that issue.

Liability Insurance From the Responsible Party

Questions about who may be responsible for an injury are a common part of a case review. The claim can cover past and future medical expenses, limited to the reasonable value of medically necessary care, treatment, or services, and other losses.

Who is responsible depends on the type of case. In car, truck, motorcycle, and pedestrian cases, it is often the at-fault driver and that driver’s insurer. In short-term rental injury cases, the property operator may be involved.

Rideshare cases follow their own rules. Under O.C.G.A. § 33-1-24, during one time period defined in the statute, a transportation network company’s insurance must provide a minimum of $1 million for death, personal injury, and property damage per occurrence. During another defined period, the required amounts are lower: $50,000 for one person’s bodily injury or death, $100,000 for all persons in one accident, and $50,000 for property damage. Under O.C.G.A. § 33-1-24(f), if the driver’s insurance that meets the statute’s coverage requirements has lapsed or ceased to exist, the transportation network company must provide coverage that becomes primary beginning with the first dollar of a claim. The liability protection in O.C.G.A. § 40-1-201 applies only if there was no negligence or criminal misconduct by the ride share network service, the service complies with the requirements of that part relating to obligations to ride share drivers and other provisions required by law, and the service conducts or causes to be conducted a criminal background check, or obtains a private background check certification, for each ride share driver at least once every two years.

Negligent security claims carry a higher bar. Except as provided in Code Section 51-3-54, an owner or occupier shall be liable for negligent security arising from any injury sustained by any person upon the premises of the owner or occupier as an invitee only if the injured person proves specific elements, including that the third person’s wrongful conduct was reasonably foreseeable and that the owner failed to use ordinary care (O.C.G.A. § 51-3-51).

Every policy has a maximum amount. A policy can be smaller than the cost of lifetime care.

Uninsured, Underinsured, and Other Coverage Sources

Uninsured motorist coverage can help when the at-fault driver has no insurance. O.C.G.A. § 33-7-11 reads: “(a)(1) No automobile liability policy or motor vehicle liability policy shall be issued or delivered in this state to the owner of such vehicle or shall be issued or delivered by any insurer licensed in this state upon any motor vehicle then principally garaged or principally used in this state unless it contains an endorsement or provisions undertaking to pay the insured damages for bodily injury, loss of consortium or death of an insured, or for injury to or destruction of property of an insured under the named insured’s policy sustained from the owner or operator of an uninsured motor vehicle, within limits exclusive of interests and costs which at the option of the insured shall be.” Underinsured motorist coverage works in a related way when the at-fault driver has too little insurance. The policy language controls how each one applies.

Other policies can matter too. An umbrella policy, a business policy for a company involved in the crash, or a homeowner’s or landlord’s policy in a premises case may all be relevant.

Workers’ compensation is the usual route for injuries on the job, and it runs on its own rules. In a catastrophic injury case, Georgia law requires the employer to provide reasonable and necessary rehabilitation services. The employer must appoint a registered rehabilitation supplier, or give reasons why rehabilitation is not needed, within the time the statute sets (O.C.G.A. § 34-9-200.1).

How Future Medical Needs Are Estimated in a Georgia Injury Claim

Future medical costs are usually supported by medical records and opinions from treating doctors. Often, a life care plan is added to the proof. A life care plan is a written projection of future care, prepared with input from medical providers and cost data.

A life care plan typically lists projected surgeries, therapy, medications, equipment replacement, and home or attendant care. It also addresses how long that care may be needed, based on medical sources.

Future costs are often reduced to today’s dollars. The law sets a 5 percent discount rate as the example, or another rate the decision-maker considers appropriate (O.C.G.A. § 51-12-13).

Georgia law also separates the two main kinds of damages. General damages are presumed to flow from the injury and do not need proof of an amount. Special damages, such as medical bills, must be proved (O.C.G.A. § 51-12-2). This is why bills, records, and receipts matter so much.

Liens, Reimbursement Claims, and Structured Settlements

Some providers treat patients under a letter of protection, which is a promise to be paid from a future settlement or judgment. In any claim for medical and healthcare expenses rendered under a letter of protection or any other arrangement, Georgia law makes the letter, itemized charges, any sale of the bills at less than invoice price, and any referral information relevant and discoverable (O.C.G.A. § 51-12-1.1).

A structured settlement pays some or all of a settlement over time. Families often use this structure to fund future care. It is one option among others.

A special needs trust is a legal tool that may help a person keep eligibility for needs-based government benefits when a settlement is involved. Whether one fits a given family depends on their situation and benefits.

Talking With a Georgia Personal Injury Firm About Lifetime Care Costs

Bring a short list to the first conversation. List the coverage you have, which programs already pay, and what future care your doctors have recommended. Note the date of the injury, too.

Timing matters. Georgia’s general deadline to file a personal injury lawsuit is generally two years (O.C.G.A. § 9-3-33). Some claims follow different timing. A person under 18 when the claim arises gets the same time to sue after turning 18 as other people get, with some exceptions (O.C.G.A. § 9-3-90). Our guide on child catastrophic injury deadlines in Georgia covers that topic.

The first consultation is free, confidential, and carries no obligation to continue.

Frequently Asked Questions