How Does Health Insurance Affect Medical Damages in a Georgia Injury Case After the 2025 Reform?
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For claims arising on or after April 21, 2025, if you have any public or private health insurance, the jury hears two numbers for your medical care: what the providers charged and what would actually satisfy those charges under your insurance contract. O.C.G.A. § 51-12-1.1(c), added by Senate Bill 68, requires both, “regardless of whether the health insurance has been used, is used, or will be used”, and subsection (e) abrogates the common law collateral source rule to the extent needed to admit that evidence.
The exact text of subsection (c)
“If the plaintiff in any such civil action has any form of public or private health insurance, including benefits under a governmental workers’ compensation program, evidence relevant to the determination of the reasonable value of medically necessary care, treatment, or services pursuant to subsection (b) of this Code section shall include both the amounts charged for past, present, or future medical and healthcare expenses and the amounts actually necessary to satisfy such charges pursuant to the insurance contract or the applicable governmental workers’ compensation program, regardless of whether the health insurance has been used, is used, or will be used to satisfy such charges”.
Three points follow from that text:
- The trigger is having insurance. The rule applies when the plaintiff “has any form of public or private health insurance”, including governmental workers’ compensation benefits.
- Both numbers are evidence, neither is the award. The award is still “the reasonable value of medically necessary care”, and the amount is “determined by the trier of fact” (§ 51-12-1.1(b)).
- Using insurance is irrelevant. A plaintiff who treated outside insurance still faces evidence of what the insurance contract would have paid.
The collateral source rule after SB 68
Subsection (e) states the General Assembly’s intent that the section “abrogates the common law collateral source rule to the extent necessary to introduce the evidence described in this Code section”. The same subsection preserves the court’s power to issue “appropriate jury instructions to clarify the role of collateral source payments and to prevent potential jury confusion regarding the effect of collateral source payments on the plaintiff’s recovery”. Subsection (f) keeps both sides’ right to challenge the reasonableness and medical necessity of any expense.
Which claims are covered
Senate Bill 68 § 9(b) makes Section 7, which enacted § 51-12-1.1, apply “only with respect to causes of action arising on or after the effective date of this Act, and any prior causes of action shall be governed by prior law”. The Act took effect on the Governor’s approval, recorded in the 2025 legislative summary as April 21, 2025. By contrast, § 9(b) states the intent that the Act’s other provisions, apart from the negligent security sections, apply to pending cases.
| Claim arose | Medical-expense rules |
|---|---|
| Before April 21, 2025 | Prior law |
| On or after April 21, 2025 | § 51-12-1.1 |
What to gather for a post-reform claim
- Itemized bills from every provider.
- Explanation of benefits statements showing what your insurer allowed and paid.
- Your insurance contract or plan documents, since subsection (c) refers to amounts necessary to satisfy charges “pursuant to the insurance contract”.
- Any letter of protection; treatment under one triggers the separate discovery rules explained in letters of protection and the 2025 law.
The statute’s effect on future care is covered in how future medical expenses are proven, and the whole 2025 package in the key provisions of SB 68.
Sources
- Senate Bill 68 (2025), as passed, LC 49 2362S, §§ 7, 9.
- Georgia General Assembly, 2025 Summary of General Statutes Enacted, entry for Act 9 (SB 68).
General information about Georgia law as of October 2026. It is not legal advice, and reading it does not create an attorney-client relationship.