Under the made whole doctrine, an insurer asserting subrogation or reimbursement cannot recover from a settlement until the insured has been made whole for the entire loss. It is a default rule in many states.
Plan language may override it in some contexts.
Alternative Names:
Made Whole Rule, Full Compensation Rule
Why it Matters?
The doctrine is most valuable where the recovery is limited by available policy limits, since a claimant recovering far less than their total loss has not been made whole and the health plan's claim may be defeated entirely. Whether plan language can override the default is the contested question, and ERISA self-funded plans have generally succeeded in doing so following Supreme Court authority on plan terms.
Frequently Confused with
Related terms
Frequently asked questions
When does the doctrine defeat a subrogation claim?
Can plan language override it?
