What is the Made Whole Doctrine?

June 7, 2019

The Made Whole Doctrine Colorado Revised Statute 10-1-135 means that the injured party must be “made whole” prior to their health insurance company.  The Made Whole Doctrine prevents the health insurance company from recovering prior to the injured party.  The law states that repayment of health insurance claim is only allowed after the injured party has been fully compensated or “made whole.”  The doctrine can operate to completely disregard a health insurers claim of subrogation.  It allows the injured party to keep all of their settlement minus fess, costs and other provider liens.  The law presumes that if the injured individual settled for Defendant’s insurance policy limits, they were not made whole and as such, the health insurer does not have a claim of subrogation against the injured party’s settlement. 

 

When can the Made Whole Doctrine be applied?

The Made Whole Doctrine does not apply to Medicare, Medicaid, or self-funded ERISA plans, Federal insurance plans, and hospital liens.

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