14 Sep Veterans Financial Assistance: Emergency Medical Expenses
Over the past several years, many veterans faced the same problem: their veterans financial assistance claims for reimbursement of emergency medical expenses from the VA were denied because a portion of the expenses were covered by Medicare. In the recent decision of Richard W. Staab v. Robert A. McDonald, the U.S. Court of Appeals for Veterans Claims ruled in favor of a veteran who faced such a situation.
Staab v. McDonald: Veterans Financial Assistance Case
The case was brought by the National Veterans Legal Services Program (NVLSP) on behalf of veteran Richard W. Staab. A former Air Force member, Staab had a heart attack that led to a stroke in December of 2010. Following the stroke, he underwent open heart surgery, cardiovascular treatment, and rehabilitative care over the course of the subsequent year. As a result of all of his treatments, Staab ended up incurring nearly $48,000 in medical expenses.
When he filed a veterans financial assistance claim for reimbursement from the VA Medical Center in Minnesota, the VA denied his claim, noting that he had partial coverage of these emergency medical expenses through Medicare.
Veterans Financial Assistance for Emergency Medical Expenses: The Appeals Process and Final Decision
Over the following months, Staab filed a Notice of Disagreement with the VA claiming that because he was incapacitated as a result of his heart attack and stroke, he was not able to secure pre-authorization for non-VA treatment and neither he, nor his family, were advised to ask for pre-approval. After a number of appeals, his claim finally made it to the U.S. Court of Appeals for Veterans Claims. The Court’s judicial panel ultimately decided that the regulation the VA relied upon in denying Staab’s reimbursement claim was invalid.
The Court ultimately found that the VA is required by the Emergency Care Fairness Act of 2009 to act as a secondary payer in these cases, even where other health care insurers like Medicare partially covered the emergency medical expenses. The Court found that the regulation the VA cited in denying Staab’s claim was not consistent with the Act, despite the Act’s clear intent that the VA adopt a role as a supplemental payer. The Court noted it was inconsistent for the VA to reimburse veterans for these claims when they had no insurance at all but not to reimburse them when they had the means for partial coverage.
Contact Our Experienced Mt Pleasant Veterans Lawyers Today
If you have filed or are planning to file a claim for reimbursement for uncovered emergency medical expenses from the VA, the skilled Mt Pleasant veterans’ lawyers at Klok Law Firm LLC can help you develop your claim to increase your chances of success.
Contact our Mount Pleasant office today for a consultation on your case.