I am service-connected for a condition that was aggravated or exacerbated in an accident or incident.
How does this affect VA’s right to reimbursement?
This is the response I received from the VA:
Care of a service-connected disability is not reimbursable to VA under this program unless an accident or incident resulted in additional care for the condition. Under those circumstances, the responsible third-party payer would be responsible for reimbursement to VA for the additional cost of care that was related to the accident/injury. 38 U.S.C. § 1729, 42 U.S.C. § 2651.
So how do find out if there is a Subrogation claim from the VA?
Thank you for helping me figure this out.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
Thank you for your question, and thank you as well for your service. The VA may have a subrogation claim in your case. It just depends on how severely your accident aggravated your service-connected condition.
Subrogation claims are often complicated to understand.
Perhaps the term is best understood if you assume that you were injured by the actions of another person, and your insurance company paid for certain medical expenses on your behalf.
In this situation, subrogation gives the insurance company the right to stand in your shoes and collect money from the person who caused your injury.
Insurance companies, and other entities, use subrogation to recover the money they have spent on your behalf from the person or business that caused your injury.
Different types of insurance companies use subrogation, such as:
- Health insurance companies
- Health maintenance organizations (HMOs)
- Workers’ compensation insurance
- Auto insurance companies
Subrogation is also used by government-run agencies like Medicare, Medicaid, and the Veterans’ Administration.
The higher your medical costs climb, the higher the likelihood that your health insurance provider will seek reimbursement when your claim settles.
VA and Subrogation
The VA does have a right to reimbursement when another party injures a veteran. The Federal Medical Care Recovery Program sets forth this right.
According to VA’s website:
“VA’s Federal Medical Care Recovery Program ensures that when a Veteran is injured, the responsible party pays for the injured Veteran’s medical care instead of the American taxpayers.”
Money recovered by this program helps each VA medical facility provide its medical care and services that every Veteran deserves by supplementing funds appropriated to VA by Congress.
VA and Subrogation Rights for a Service-Connected Disability
When it comes to service-connected disabilities, VA has a subrogation claim only under certain circumstances.
As noted by the VA response you received, care of a service-connected disability is not reimbursable to VA under the Federal Medical Care Recovery Program unless an accident or incident resulted in additional care for the condition.
Under these circumstances, the responsible third-party payer would be responsible for reimbursement to VA for the additional cost of care that was related to the accident/injury. This information is included on VA’s website as well.
The critical question in your case then becomes whether the accident you experienced caused additional care for your service-connected disability. “Additional care” is care above what would have been necessary if the accident never occurred.
If there is additional care, then the VA has a legitimate subrogation claim and can pursue recovery against the party that caused your accident.
Your VA doctor can likely tell you if this additional care element is met. If not, you can speak with a private doctor to get their opinion.
Arizona and the Anti-Subrogation Rule
Some people become nervous or surprised when they learn that an insurer or care provider can receive compensation from the same accident that harmed them.
We want to point out that Arizona law provides some protection to an injured party when it comes to subrogation claims.
The “Anti-Subrogation Rule” is a type of defense to subrogation. Every state in the U.S. has one.
In Arizona, the rule provides that a subrogated insurance company standing in the shoes of its insured cannot bring a subrogation action against or sue its own insured.
This rule means that the VA can’t exercise its right of reimbursement against you. It can only do so against the party that was responsible for your injury.
Again, subrogation matters can grow complex. For this reason, you may want to discuss your case with a local personal injury attorney. Most offer a free consultation, so asking a few questions won’t cost you a dime.
Learn more here: How Subrogation Impacts Injury Claims
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
We wish you the best with your claim,
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