I thought Veterans were entitled to medical care without charge. Why is VA seeking reimbursement?

Veterans are not provided care without charge for non-service connected disabilities if one or more of the following is responsible for the cost of that care: 

  1. A tortfeasor and/or their insurer (common examples are motor vehicle insurance, medical malpractice insurance, homeowners insurance);
  2. Veteran's own insurance (common examples are motor vehicle insurance including no-fault or auto reparation insurance, underinsured or uninsured motorist coverage); or
  3. Workers' compensation insurance.

How are VA’s medical charges determined?

The VA’s “reasonable charges” are determined in accordance with federal law and regulation. The regulation contains formulas to determine the charge for the care which take into account the type of care and other variables such as the geographic area where the service was provided. All rates are published in the Federal Register. 38 C.F.R. § 17.101(a)(2). 

Will VA file its own lawsuit?

Not usually. The government may independently institute an action for recovery in federal court; it may intervene in the underlying case and seek removal of the case to federal court; or, it may assert a subrogation claim in the underlying case. Unless otherwise advised, VA asserts a subrogation claim rather than exercising the government’s right to institute an action or intervene. In so doing, VA works collaboratively with the Veteran and the Veteran retains control of the personal injury/workers compensation case. 38 U.S.C. § 1729, 42 U.S.C. § 2651. 

I am service-connected for a condition that was aggravated in an incident. Can the VA recover?

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. 

What is an Attorney Protection Agreement and does the Veteran’s attorney have to sign this document?

The United States Government directs the recovery units to send this form to the Plaintiff’s attorney to ensure cooperation and seek written agreement that the Government will be protected in the injured parties action through subrogation. This document acknowledges the VA’s claim pursuant to 32 C.F.R § 757.18. The FMCRA provides VA with both a subrogee/intervention right and an independent right of recovery to payments when a third party is responsible for payments for all or part of the same medical treatment for which VA provided or made payment to a non-government provider. 

Does the VA reduce(offset) its Claim for attorney’s fees and costs?

No. The Government asserts a prohibition from paying private counsel fees pursuant to 5 U.S.C. § 3106.