The United States is required to recover the value of medical care furnished to service members, retirees and their Family members when an independent source of payment exists rather than disbursing funds from the U.S. Treasury (tax dollars).
TRICARE beneficiaries are required to report all incidents which may lead to successful recovery and cooperate with the investigation and recovery efforts. Beneficiaries who fail to cooperate may find that TRICARE will (1) not reimburse private healthcare providers for care provided outside a military treatment facility and (2) deny beneficiaries future medical services.
Recovery can be directly from a person who has wrongfully or negligently caused injury to a TRICARE beneficiary or from another source (third party) who may be legally obligated to pay for the care such as an automobile, property liability, or supplemental health insurance provider or a worker's compensation fund.
The United States is also required to recover the value of any damage to U.S. property not caused by its employees and resulting from another's wrongful or negligent conduct.
The following are all examples of incidents that would require the United States to recoup expenses:
A service member crossing the street is struck and injured by an inattentive driver who runs a red light. The service member requires one week of hospitalization and three months of physical therapy at Kirk U.S. Army Health Clinic. The United States can recover from the negligent driver directly or from the driver's insurance company.
A military retiree now working for a private construction firm is injured when scaffolding collapses at work. The retiree requires an emergency room visit and follow-up care at KUSAHC. The United States can recover from the construction company through the company's property liability insurance or from a worker's compensation fund.
A retired service member's child is assaulted by a fellow student at the local high school and requires an emergency room visit and follow up care at KUSAHC. The United States can recover directly from the child who wrongfully assaulted the TRICARE beneficiary or from that child's legal guardian.
A private citizen (not a U.S. employee) carelessly depresses the gas pedal instead of the brake pedal when entering post to attend a summer concert and strikes a security booth causing $15,000 in damages to U.S. property. The United States can recover from the negligent driver directly or from the driver's insurance company.
The Client Services Division, Office of the Staff Judge Advocate, is responsible for investigating and pursuing claims for all care received as a result of an intentional or negligent injury to a U.S. Army TRICARE beneficiary and property damage claims arising in northern Maryland and the entire state of Delaware. The staff of the Client Services Division works closely with KUSAHC and TRICARE representatives, service member and retiree beneficiaries and property accountability officers to identify and aggressively pursue potentially compensable events.
Successfully recovered expenses not only reduce the need for disbursements from the U.S. Treasury, they also benefit service members, retirees and Family members directly.
In the case of care provided at KUSAHC, recovered expenses are directly deposited into an account which may be used for the operation and maintenance of the medical treatment facility. That means that every successfully recovered dollar goes right back to the health clinic and is available to improve the quality of the services provided.
In the first half of the 2009 fiscal year, the Client Services Division recovered more than $79,516 of which $17,516 was returned to KUSAHC.
As discussed earlier, service members and retirees are required to report all incidents which may lead to successful recovery, and cooperate with investigation and recovery efforts or face denial of reimbursement for care sought outside a military treatment facility and denial of future medical services.
Department of Defense Form 2527 Statement of Personal Injury, Personal Injury, (January 2008) should be used to report all incidents. Injured service members and retirees should not execute a release or settle any claims without first coordinating with the staff of the Client Services Division to determine how that might effect the recovery process.
Any TRICARE beneficiary injured as a result of someone's intentional or negligent act or has information regarding an incident in which a non-United States employee damaged government property, should notify the staff of the Client Services Division immediately by calling 410-278-1583 or report the incident in person at the OSJA office on the third floor of building 4305, Susquehanna Avenue.
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