Medical Care Recovery (Continued from page 34)
the government’s claim applies. (See, Title 5 of the United States Code Section 3106).
This statutory background should help counsel understand the government’s rights, but the important thing for your client will be her recovery from the per- son who injured her and her family. To start building the case, the first thing that must be done is to identify the service af- filiation of the military client or retiree, and where they are stationed or receive their medical care. With that informa- tion, counsel can contact the proper party to get medical records and bills. By work- ing through one of the local Office of the Staff Judge Advocate (OSJA) claims of- fices, below, counsel can expedite the request by avoiding having the records and billing office refer the matter to the OSJA for investigation. AIR FORCE SERVICE MEMBERS OR RETIREES. Dover AFB 436 AW/ JA, 200 Eagle Way, Dover AFB DE 19902-7216, (302)-677-5086; Andrews AFB, 89 AW/JA, 1535 Command Drive, Suite AA210, Andrews AFB MD 20762- 7002, (301)-981-2042; Bolling AFB 11 WG/JA, 20 MacDill Boulevard, Suite 240, Bolling AFB, DC 20032-0110, (202)-767-5297.
ARMY SERVICE MEMBERS OR RETIREES. Fort George G. Meade, OSJA, 2257 Huber Road, Fort Meade, MD 20755-5030, (301) 677-9898; APG OSJA, 2201 Aberdeen Boulevard, Aber- deen Proving Ground, MD 21005-5001, (410) 278-1591; Walter Reed AMC, 6900 Georgia Avenue NW, Building #1, Washington, DC 20307-5001, (202) 782-1550. NAVY SERVICE MEMBERS OR RETIREES. Office of the Judge Advo- cate General, Department of the Navy, Medcare Recovery, 9620 Maryland Av- enue, Norfolk, VA 23511, (757) 444-3657. After you have the medical records and medical bills from the military hospital, and the civilian bills from TRICARE, you should be ready to proceed with your de- mand against the negligent party’s insurance company. A practical consid- eration at this point is that the military billing rates and the TRICARE reim- bursement rates are relatively low and could adversely affect settlement offers. Counsel can simply point out these low rates in the demand or go the extra step and recalculate the military bills to reflect industry averages, and avoid any preju- dice that might be caused by low medical bills. Hopefully, your demand will be met with an adequate settlement, but if it is
not, you can request a compromise or waiver of the United States’ claim for medical care. The applicable statutes pro- vide the United States with authority to compromise or waive a claim when cer- tain conditions are met. A request for compromise or waiver should be submit- ted to the OSJA that was contacted for records and bills. Depending on the amount involved, a request will be for- warded to the U.S. Army Claims Service or to the Department of Justice for ap- proval. Requests for compromise are evaluated and based on the principle that there should be a fair allocation of the settle- ment proceeds between the injured party and the U.S. based on the individual facts of each case. Factors include the settle- ment proceeds and ability of the defendant to pay, the strength or weak- ness of the facts, the injuries and individual circumstance of the injured party, the law, evidence and likelihood of success on the merits, and any other rel- evant fact. Waivers are only granted in cases where collection of any money from the settlement would present an undue hardship on the injured party. Additional factors considered are the prognosis, dis- ability, financial loss, lost earning potential, present assets, out-of-pocket expenses and future government benefits accruing to the injured party. The decisions to grant requests for com-
promise or waiver are not similar to the “business decisions” made by civilian health insurers. Often, the injured party is or was a member of the Uniformed Ser- vices and is not simply a client of a health insurance plan. The military Services also have a vested interest in ensuring that ser- vice members and their families are made whole so that the service member can re- turn to serving the country.
Another
unique aspect of government claims is that if the injured party suffered a serious dis- ability, he or she is likely to be using other governmental programs, and putting money in one of Uncle Sam’s pockets only to have it taken out of another, is not effi- cient. With this knowledge, counsel should
have confidence in assisting military cli- ents on personal injury claims. Although military medical claims are different from traditional liens, the case management process can proceed as with a traditional personal injury case with a lien, if coun- sel recognizes the legal and practical differences and works with, not against, the bureaucracy. By working with the military, the best result will be achieved for all involved parties.
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