2010 UBO/UBU Conference Health Budgets & Financial Policy Briefing:Medical Affirmative Claims Date:24 March 2010 Time:1110 – 1200

2010 UBO/UBU Conference Turning Knowledge Into Action Statutory Authority Federal Medical Care Recovery Act, 42 USC – Against “third party” insurance belonging to negligent third party 10 USC 1095 – Against the patient’s “first party” insurance – Same statute that authorizes health insurance claims 2

2010 UBO/UBU Conference Turning Knowledge Into Action Army Regulations AR 27-20, Chapter 14 AR , Chapter 13 3

2010 UBO/UBU Conference Turning Knowledge Into Action Types of Affirmative Claims Medical Affirmative Claims (MAC) - All insurance recoveries EXCEPT health insurance Property Damage Recoveries Lost Wage Claims 4

2010 UBO/UBU Conference Turning Knowledge Into Action How Are MAC Claims Different? Unlike TPCP (health insurance claims): Can assert for medical care provided to soldiers Requires more proof/advocacy by legal offices and possible litigation Authority to collect resides with legal offices per OTSG/OTJAG MOU and Army Regulations Billing issues 5

2010 UBO/UBU Conference Turning Knowledge Into Action Types of MAC Claims Auto Accidents Workers Compensation Premises Liability Products Liability Assaults Medical Malpractice 6

2010 UBO/UBU Conference Turning Knowledge Into Action Auto Insurance State-specific: See finder.com (for summary of insurance laws of 50 states) finder.com Liability Coverage UM Coverage (uninsurance & underinsurance) Medical Payments Coverage Personal Injury Protection 7

2010 UBO/UBU Conference Turning Knowledge Into Action Example – Kansas Law Required Coverage Liability - $25,000 per person/$50,000 per accident UM coverage (cannot stack with liability) - $25,000 per person/$50,000 per accident PIP coverage - $4,500 per person Hypothetical: What happens if our medical claim is $100,000? 8

2010 UBO/UBU Conference Turning Knowledge Into Action Workers Compensation Non-federal employer On-the-job injuries State-specific forms and filing requirements 9

2010 UBO/UBU Conference Turning Knowledge Into Action Homeowners Insurance Renters Insurance RCI Privatized On-Post Housing All have liability and most have minimal no-fault insurance 10 Premises Liability

2010 UBO/UBU Conference Turning Knowledge Into Action MP Blotters Serious Incident Reports Newspapers Local civilian police reports Line-of-Duty investigations TRICARE fiscal intermediaries 11 Identifying Potential MAC Claims

2010 UBO/UBU Conference Turning Knowledge Into Action MTF Support Identifying MAC Claims Screen ER logs Develop Injury Treatment Questionnaire with legal office and require completion by patients Refer all attorney and insurance requests for records/bills to supporting legal office AR , Chapter 13 – requires coordinated effort between UBO and servicing legal office Coordinate billing efforts 12

2010 UBO/UBU Conference Turning Knowledge Into Action Sample Questionnaire 13

2010 UBO/UBU Conference Turning Knowledge Into Action Where Does the Money Go? MTF Care - $$$ to MTF TRICARE - $$$ to TRICARE Proportional Distribution if MTF care and TRICARE TSG/TJAG MOU (1991) – MTF funding of legal office MAC recovery slots TSG/OTJAG/TRICARE MOU (2009) – TRICARE reimburses MTF for percentage of MTF-funded legal office MAC recovery slots 14

2010 UBO/UBU Conference Turning Knowledge Into Action MAC Billing Issues Time intensive What rates to use? 15

2010 UBO/UBU Conference Turning Knowledge Into Action Settling Medical Claims Payment in full? Compromise? Waiver? Termination? Litigation? Decision may reside at DA or DOJ level 16

2010 UBO/UBU Conference Turning Knowledge Into Action 17 Quiz MVA in Kansas. Our injured has MTF bill for $20,000 Our injured also has TRICARE payout of $40,000 Tortfeasor has insurance coverage of $25,000/$50,000 Our injured has UM coverage of $100, What insurance is potentially available? 2. What factors impact how much we recover? 3. Where does the $$$ go?

2010 UBO/UBU Conference Turning Knowledge Into Action Q&A Questions? 18