Many U.S. servicemembers, veterans, and their family members depend on TRICARE benefits when they need medical treatment for non-military service-related illnesses and injuries, from regular preventative care to emergency treatment after serious car wrecks and other accidents.
However, when using TRICARE, there are laws that prevent the solider or dependant from being compensated for the cost of treatment for the same injury twice. This means if TRICARE covers the cost of your treatment after a car wreck, and then later the auto insurance of the person who hit you agrees to pay for the cost of your medical treatment, you must usually pay back what TRICARE paid with what you receive from the auto insurance company.
Related Reading: Do I Have to Pay Back My Health Insurance If I Settle My Case?
However, this DOES NOT mean that you are just borrowing from Peter to pay Paul. Even if you have to repay your health insurer from any personal injury settlement you get, filing a personal injury claim is still the best way to ensure you get compensated fully for your injuries and related expenses.
You will likely find that your health insurance does not completely cover all of your medical treatments after an accident, and it definitely doesn’t compensate you for your pain and suffering, or for how much work (and pay) you missed while recovering. A personal injury claim DOES, so you will still have money left over even after paying back your health insurer.
However, with the help of an experienced lawyer, it is sometimes possible to reduce the amount of money you need to pay back to your health insurer, even if it is TRICARE, so you have more compensation left over.
Reasons TRICARE Liens May Be Reduced or Waived
A “lien” is filed by the J.A.G. office for TRICARE or other insurers asserting a right to seek reimbursement from your injury settlement. Unlike other insurers, however, TRICARE take priority. It’s paid first—even before your lawyer takes his or her fees—and there is no cap on how much it can take from your settlement in reimbursement.
This could be very bad for injured victims if the TRICARE claim couldn’t be reduced. For example, an injury victim could have $30,000 in medical expenses after a wreck, but the person who hit them could have only purchased the minimum amount of liability insurance required by Georgia law ($25,000).
TRICARE is legally allowed to request the full $30,000 it paid in reimbursement anyway, meaning the injury victim is now $5,000 in the hole even after filing a lawsuit against the other driver and getting compensation. (TRICARE will not, however, seek more than the coverage).
Nevertheless, there are times the government may agree to reduce or waive the lien. A skilled lawyer experienced with negotiating with TRICARE can help you determine if you are eligible for a reduction or waiver and fight for it on your behalf. We have worked hard over the years to find ways to make a bad situation with TRICARE better.
First, the restriction on TRICARE liens is that they can only take reimbursement for medical expenses specifically related to the injury you filed your personal injury claim over.
For example, if you were prescribed pain medication for your car wreck injuries and antibiotics for an unrelated illness and TRICARE paid for both, it is only allowed to ask to be reimbursed for the cost of the pain medication, not everything it paid for in that time period. Make sure to request an itemized list of the charges it is requesting reimbursement for and have your lawyer look it over to make sure all the charges are legitimate and related. Sometimes, through oversight, unrelated bills are claimed. We fix that.
After severe injuries, victims often need ongoing treatment. A lawyer can argue that you need the full amount of the settlement received to cover your future medical expenses, since you haven’t fully recovered yet. This happens on serious cases even with large limits of coverage. It is not handled locally at Ft. Benning in serious cases, but the process starts here. We handle that.
One of the most common reasons why a TRICARE lien could be reduced or waived is “undue hardship.” This usually means that you were or are unable to return to work because of your injuries and therefore haven’t been able to earn a living wage.
TRICARE may agree to reduce or waive its lien if it does not leave enough money left over in your settlement for you to pay your usual bills, like rent and groceries, because it would be unjust to leave you in a financially worse position than you started in because of an injury that wasn’t your fault. Sometimes the government lawyers listen. They actually do help many times in bad situations. We know.
Pain and Suffering
You can also request a reduction or waiver if you can successfully argue that the amount of settlement left over after the lien is taken out does not fairly compensate you for your pain and suffering. This is based on a doctrine called “made whole.” If you are not “made whole” by the result, then the burden of getting less compensation should fall on the health insurance company or government because they took premiums to provide coverage and frankly, they never counted on the recovery to begin with.
Get Gary Bruce If You Need Help Negotiating Your TRICARE Lien
Our firm has been proudly serving military families stationed at Ft. Benning for many years, and we know our way around the complexities that get added to an injury case when TRICARE is involved.
Contact our firm today for a free consultation and learn how we can help you get and keep the full compensation you are entitled to after an injury that wasn’t your fault.