TRICARE liens on a car accident claim can be reduced for several reasons including unrelated treatment, future medical care expenses and undue hardship.
TRICARE Liens and Car Accidents
You’re in a car accident. You’re injured. It’s not your fault, and you have a claim for compensation against the at-fault party and their insurance company. You seek medical care using your TRICARE benefits.
Then, you learn that TRICARE wants to recover the cost of your medical care from your car accident claim.
U.S. law allows TRICARE to recover the cost of medical care from a third party who is at fault for an accident. However, TRICARE often wants a significant part of your settlement. They may even put a lien on the entire amount.
If this happens to you, you should know that TRICARE liens on a car accident can be reduced.
You may negotiate with TRICARE to reduce or waive the amount they are seeking for your medical care.
There are several grounds for reduction that may apply in your case.
Our lawyers can help. Contact Horton & Mendez for a free case review, and get legal help today.
Understanding TRICARE Liens on Car Accident Compensation
- 32 U.S.C. §§ 2651-2653 states that TRICARE may seek reimbursement for medical care provided for a car accident claim or other type of personal injury.
- TRICARE may seek the reasonable value of care and treatment. This may include hospital, medical, surgical and dental care and treatment.
- JAG representatives may waive TRICARE’s interest or accept a lower amount.
- A lawyer can represent you in the negotiations process.
The purpose of the law is to prevent a financial windfall or double recovery. Since TRICARE is the entity absorbing the cost for the victim’s medical care, the law says that they should be reimbursed first from the proceeds of the settlement.
What grounds are there to reduce a TRICARE lien on a car accident settlement?
Grounds to reduce a TRICARE lien on a car accident settlement may include:
- Unrelated treatment: Compensation was claimed for treatment that was unrelated to the car accident. A lien may claim only cost of care related to the car accident, and not all care received within a specific period.
- Future medical care posts: The person is likely to need medical care in the future, and funds must come from the settlement to pay for it.
- Undue hardship: Recovering the full amount of the claim would cause undue hardship to the injured person.
- Collection not feasible: Circumstances where the tortfeasor can’t be found, if they can’t pay a judgment or if litigation is not feasible.
Undue hardship is often the basis for negotiation to reduce a TRICARE lien. Otherwise, the injured person may be left without resources to pay basic living expenses.
Factors that may be considered when determining undue hardship include:
- Disability and disfigurement
- Lost earning capacity
- Out-of-pocket expenses
- The person’s financial resources in general
- Access to disability, pension and other benefits
- The amount of the settlement or award
- Other factors that should be considered
Effective negotiation means presenting a complete picture to those representing TRICARE of why a waiver is appropriate. Our attorneys can assist you in preparing this information and negotiating on your behalf.
What is the law that allows TRICARE to put a lien on car accident compensation?
What if my car accident compensation is more than the amount TRICARE is seeking?
To the extent that your car accident compensation is more than the TRICARE lien amount, you may keep the funds. The law clarifies that it is not intended to deny a person the portion of their damages not claimed by the lien.
Does TRICARE cover me in a car accident?
TRICARE is health insurance that will provide medical care to an insured person who is injured in a car accident. However, it doesn’t cover liability or provide compensation for damages. You need car insurance in place to protect yourself in the event of an accident.
Does TRICARE have subrogation rights?
Under 32 U.S.C. § 2651, TRICARE has subrogation rights for the reasonable value of care and treatment furnished because of injury or disease, when the person has a claim against a third person to pay damages.
Do federal medical care recovery laws apply to Veterans Affairs services?
Services provided by the Department of Veterans affairs to eligible veterans are exempt from federal medical care financial recovery laws. The exception includes prosthesis and medical appliances.
What if I refuse to bring an action for damages or I don’t include TRICARE’s interest?
JAG can pursue independent collection of your claim. In addition, they may join in any legal action. If you decline to complete Form 2527, TRICARE may suspend payment.
What is DD Form 2527?
DD Form 2527 is the form to provide information to TRICARE when third parties may be liable for medical care resulting from injuries. The form gives the patient’s basic information, injury details, military medical facilities involved in providing care, your lawyer’s information and insurance details. The form allows TRICARE representatives to investigate and take further action.