Emergency Care at Non-VA Health Care Facilities

19 Jan 2017

Getting emergency health care in a non-VA health care facility paid for by the Veterans Administration is allowed but often difficult for veterans to succeed at.  There are very strict guidelines to this benefit.  A veteran trying to get their non-VA emergency room visit paid for must meet ALL the requirements.

The first requirement is the ER visit must meet the definition of an emergency.  The definition of an emergency is based on the “prudent layperson” standard that a delay in care would be hazardous to life or health.  This is often a difficult test for a veteran to argue with a VA administrator.

Veterans must use the VA for healthcare and be registered as a VA patient.  It is not an exclusive requirement that the veteran receive all their health care at the VA but the veteran must have accessed health care at a VA facility within 24 months prior to the emergency room visit.

The veteran cannot have any other insurance nor can a third-party have any liability for the illness or injury which the veteran is seeking care.  This could include workman comp and other situations when a third-party caused the illness or injury.

There can be no VA health care facility reasonably accessible when treatment for the condition is received. 

The VA also wants to be notified in advance.  This is not always reasonably possible but usually expected.  Veterans are advised to contact the VA as soon as possible after receiving emergency care.  A recommended way to meet this requirement is to have the ER physician contact the closest VA facility to consult with the VA ER physician on a treatment plan.  The VA may want to transfer the veteran to the VA facility for further treatment and/or assessment. 

Once the VA receives the bills for care, they will either pay the bills or notify the veteran of a denial.  The denial can be appealed.  The appeal must be made with one year of the denial letter. Get legal assistance as soon as possible in the event of a denial.  Experienced attorneys can help process this important appeal increasing your chances of an approved payment for your emergency care.

VA Medical Malpractice and Claims Under 38 U.S.C. § 1151

09 Sep 2016

When a veteran suffers disability or death as a consequence of VA sponsored medical treatment, that veteran or their surviving family is entitled to compensation under 38 U.S.C. § 1151. Unlike other VA claims, these are not considered "service related," however they are compensated in a similar manner. Similar laws provide compensation when a veteran is disabled or dies as a result of VA sponsored vocational rehabilitation or work therapy.

A major benefit of this law is that claims under §1151 may be brought at any time. There is no statute of limitations for these claims. This contrasts with traditional medical malpractice claims, which can be brought against the VA under the Federal Torts Claim Act (FTCA), which are subject to a two-year statute of limitations.

Compensation under §1151 is also easier to get than a FTCA claim. Unlike FTCA medical malpractice claim, under this law negligence need not necessarily be shown. Compensation is due if there was medical malpractice or if the harm was unforeseeable. A veteran claimant need only prove one of those things.

Veterans that have suffered harm can file claims under both the FTCA and §1151, however they will not be allowed to double-recover. The amount granted by one claim will simply be deducted from the award of a latter claim.

If you have suffered harm as a result of VA sponsored medical care, it is important to have an experienced veterans rights attorney evaluate your case to determine if you have a valid claim under 38 U.S.C. § 1151. If you have lost a loved one, Similar claims are available if the harm came as a result of vocational rehabilitation or work therapy. The Veterans Law Group is dedicated to helping veterans exercise and protect their legal rights. Please, contact us if you would more information.


Texas Veterans Will No Longer Be Able to Pass on Unused College Tuition Benefits to Children

19 Apr 2015

A new measure that was introduced in Texas recently would ensure that some military veterans in that state would not be able to pass on unused state tuition benefits to their children.

The measure was introduced in the Senate recently, and was approved by the Senate. Under the bill, non-Texas veterans would have to live in the state for at least eight years before they are able to claim tuition benefits for themselves or their families. That measure is in response to a recent ruling that held that the current rules that only allow Texas residents to benefit from the program was unconstitutional.

That ruling raised concerns that hundreds of thousands of veterans around the country who were enlisted, would move to Texas to claim these benefits for themselves and their children. The concern was that these were people would move to Texas, and would live for just one year to establish residency for the sole purpose of claiming these benefits.

Those state tuition benefits are provided under a program called Hazelwood. In 2009, the Texas Legislature voted to expand the program, so that veterans could pass on approximate 120 out of 150 unused college tuition credit hours to their heirs or dependents.

The program is very expensive, and according to education officials, other students have had to suffer higher tuition because of the escalating cost of these fee waivers on children of military personnel. The program has expanded rapidly over the past six years, and now costs Texas $170 million. If the program continues in this manner, state officials expect that the cost will increase to more than $350 million by the end of 2019.

Whistleblowers Claim Veterans’ Informal Claims Were Thrown Out

21 Feb 2015

An investigation by CBS has found widespread mismanagement at the Department Of Veterans Affairs with the result that many veterans were denied benefits even when they were eligible for these.

Every year, the Veterans Benefit Administration processes disability claims for veterans, providing them approximately $95 billion, in disability, pension and other benefits. However, widespread mismanagement at the agency has resulted in many claims simply being denied, and veterans being robbed of their due benefits. In many cases, veterans died even as they waited for a response from the Veterans Affairs.

All of these problems were uncovered recently by an investigation which was kicked off after the scandal at the Veterans Affairs Hospital at Phoenix. At least five whistleblowers at the Oakland California Veterans Benefits office, told investigators at CBS News, that there were more than 13000 informal claims that were filed between 1996 and 2009 and stored in a file cabinet at the office. Those claims were simply ignored until 2012. Some of the letters that were sent out after those claims began to be processed, involved veterans who died during that period of time.

According to the whistleblowers, there were many informal letters from veterans, who were at the end of their lives, begging for a chance to claim benefits. Informal claims are filed by veterans who want to apply for benefits, and Veterans Affairs is required under the law to provide these vets with an application.

Supervisors at the office however simply ordered staff members to write “no action necessary” on the claims, and threw them aside. Some of these veterans and their families were not even aware of the type of benefits that they were eligible for, and the veterans in these cases died before they even got a chance to find out.

To file a claim for veterans benefits or understand what types of benefits you are eligible for, speak to a California veterans disability benefits attorney.

New Benefits Claims Process Likely to Confuse Older Veterans

07 Feb 2015

The Department of Veterans Affairs has introduced new benefits application forms that it says are simple to use. However, the new system is confusing, especially for older veterans, and those who suffer from traumatic brain injuries.

Under the new policies, which will take effect on March 24, the informal claim process that earlier allowed veterans to kick start the process of filing a claim by making a written request for a claim process, will be eliminated. Under the earlier policy, veterans were able to file informal claims and had a period of one year to file a claim. Any benefits would immediately be backdated to the day that the informal request was filed.

Under the new changed policies however, veterans must fill out a new standardized form to start the claims process. This means that when a vet is not able to fill out the form correctly, he will simply lose months of benefits that he was eligible for under the earlier policy.

During this period of time, he must wait for the agency to inform him of the mistakes in his form. For older veterans, the process is likely to be especially mentally taxing and exhausting. Besides, the new policies don’t make it clear how long the agency has before it informs a veteran that the form has been filled in inaccurately, and must be redone.

According to representatives of the Veterans Of Foreign Wars and Disabled American Veterans, the new system places older veterans who want to start the process of filing a claim at great inconvenience and at risk of delayed benefits. It also makes it more difficult for veterans who suffer from brain injuries. According to the veterans, these changes are not really beneficial for veterans.

For help filing a veterans’ disability benefits claim, speak to a California veterans’ benefits lawyer.

Massive Backlog of Veterans Disability Claims Appeals

25 Sep 2013

The Veterans Administration has been touting its progress in helping reduce the number of veterans disability claims that are pending processing. However, while that may be true, the fact is that there is also a huge backlog of disability claims appeals filed by veterans, who believe that their claims were wrongfully denied.

It is estimated that there are more than 200,000 veterans, who are currently in the process of appealing disability claims. These veterans say that the lengthy waiting times for appeals are unfair to them. In many cases, veterans have been waiting for four years or more for a single ruling.

According to statistics by the Department Of Veterans Affairs, there are approximately 250,651 veterans, who are currently appealing decisions by the Department of Veterans Affairs. That is an increase of approximately 50% since the current administration took over office. The Board of Veterans Appeals also expects the number of pending disability claims appeals to increase over the next four years.

Not surprisingly, feelings of resentment and frustration are high among veterans who believe that they're being made to wait too long for their cases to be heard. In many of these cases, the decisions on the claims came after months and months of excruciating waiting. According to many insiders, the reason for the backlog in disability claims appeals is the fact that many of the staff members who were earlier entrusted with dealing with disability claims appeals have now been diverted to dealing with reducing the disability claims backlog.

The Veterans Affairs has been under severe criticism because of the size of its disability claims backlog, and many staff members have been diverted towards these activities, leaving appeals hanging.

VA Makes Progress in Reducing Claims Backlog

20 Jul 2013

The Veteran Affairs Department will cross an important milestone soon. The agency announced recently that it expects to go below the 800,000 mark in its veteran disability benefits claim backlog soon.

According to the Department of Veterans Affairs, it's been a while since the department has managed to go below the 800,000 mark, and excitement has been high at the prospect of crossing that important milestone. The agency now reports that it has a total of 833,130 pending claims. Out of these, more than 547,000 claims have been backlogged for more than 125 days.

Those numbers include pending claims that don't require a rating, and the total number of claims that require a rating currently stands at 801,931 claims. Just last week, the Department of Veterans Affairs announced that there were now 808,074 claims that were awaiting ratings. The new numbers represent a drop of 6,143 claims awaiting ratings.

Also recently, the Department of Veterans Affairs admitted that in two months’ time, it had managed to process 65,000 disability claims that have been pending for more than two years. That comprises more than 97% of claims that have been pending for more than a period of two years. That progress was made due to a special initiative that was kicked off in April at the agency. Under the initiative, the Department of Veterans Affairs began assigning high-priority to older claims, and as a result, processing was finished much quicker, with faster speeding up of two-year-old claims.

The Department of Veterans Affairs has been under tremendous pressure to speed up processing of claims. Back in March, the inventory was approximately 900,000. In fact, in May, the VA Secretary imposed mandatory overtime on claims examiners in order to speed up processing.

Too Many Veterans Don't Live to Receive Benefits

08 Jan 2013

Any California veterans benefits lawyer knows that processing of benefits claims can take months. Unfortunately, in too many cases, the delays are so long that the claim processing is completed only after the veteran's death. According to a new report, cases in which the claim is processed only after the veteran’s death are becoming increasingly common.

The report has been published by the Center for Investigative Reporting, which claims that such delayed processing of claims is leading to thousands of veterans dying, before they are approved for the benefits and pensions that are due to them. According to the estimates, in the fiscal year ending September 2012, the Veterans Administration paid out $437 million in retroactive benefits to survivors of veterans who died while they waited for the claim to be approved. These unfortunate veterans, who didn't live see their claim approved, include World War II vets and Iraqi war veterans. The causes of death ranged all the way from natural causes waiting for their veteran’s pension, to suicide because claims were denied.

In all, it is estimated that close to 19,500 veterans died while they were waiting for their claim to be approved. Those numbers are a dramatic spike from just 3 years ago, when survivors of less than 6,400 veterans received retroactive benefits. The number of survivors of veterans, including widows and children, waiting for benefits has increased from less than 3,000 back in December 2009, to a high of 13,000 in January 2013.

In fact, so heavy is the backlog of veteran’s benefits claims that many lawmakers and California veterans benefits lawyers are calling it a national embarrassment.

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