Court Rules VA Must Reimburse Vets for Emergency Care Claims

The Department of Veterans Affairs (VA) is required to reimburse hundreds of thousands of veterans’ claims for emergency care at non-VA facilities, a federal appeals court ruled Monday.

Based on the federal agency’s past estimates, it must shell out $1.8 billion to $6.5 billion in claims filed or expected from 2016 to 2025, says the National Veterans Legal Services Program, which represented two plaintiffs in the case.

The U.S. Court of Appeals for Veterans Claims ruled that the VA’s reimbursement regulation violated previous legislation that required it to pay back veterans for expenses that private insurance doesn’t cover at non-VA facilities. The court certified the case as a class action, ordering the agency to provide reimbursement for all past and future out-of-pocket emergency expenses other than copays, legal services program officials say.

“VA was affirmatively informing veterans that they were not entitled to reimbursement for non-VA emergency medical care if they had any insurance covering the service at issue. In other words, the agency was telling veterans that the law was exactly opposite to what a federal court had held the law to be,” the appeals court ruling says.

After the ruling, a VA spokeswoman told AARP in an email that the department is “aware of this decision and reviewing it.”

Two veterans whose claims had been denied brought the case before the court:

• Amanda Wolfe, a U.S. Coast Guard veteran who served during Hurricane Katrina, underwent an emergency appendectomy and was in critical condition. The VA denied her $2,558.54 claim a month after it issued a replacement regulation; that amount was what she owed in copayments, deductibles and coinsurance after her employer-sponsored insurance paid most of the charges.