Court rules VA must pay for veterans' emergency room care
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Court rules VA must pay for veterans' emergency room care
WASHINGTON 10 September 2019 — The Department of Veterans
Affairs must reimburse veterans for emergency medical care at non-VA
facilities, a federal appeals court ruled Monday — a decision that could
be worth billions of dollars to veterans.

The U.S. Court of Appeals for Veterans Claims said the VA has been
wrongfully denying reimbursement to veterans who sought emergency
medical care at non-VA facilities, and struck down an internal VA
regulation that blocked those payments.

"All of this is unacceptable," said the ruling, which ordered the VA
secretary to "readjudicate these reimbursement claims."
Plaintiffs' lawyers say that based on past estimates by the VA, the
department is now on the hook for between $1.8 billion and $6.5 billion
in reimbursements to hundreds of thousands of veterans who have
filed or will file claims between 2016 and 2025.

The Official Ruling
It is ORDERED that the Wolfe Class is certified as defined here:
"All claimants whose claims for reimbursement of emergency
medical expenses incurred at non-VA facilities VA has already
denied or will deny, in whole or in part, on the ground that the
expenses are part of the deductible or coinsurance payments for
which the veteran was responsible."

It is further ORDERED that Mark B. Blocker, Esq., of Sidley Austin
LLP, and Barton F. Stichman, Esq., of the National Veterans Legal
Services Program, are appointed as class counsel.

It is further ORDERED that 38 C.F.R. § 17.1005(a)(5) is invalid
because it is contrary to 38 U.S.C. § 1725.

It is further ORDERED that the Secretary's decisions made under §
17.1005(a)(5), to the extent they denied reimbursement to Wolfe
Class members for medical expenses deemed deductibles or
coinsurance, in whole or in part, are invalid.

It is further ORDERED that Secretary must readjudicate these
reimbursement claims under section 1725's proper interpretation.

It is further ORDERED the Secretary stop sending its corrective
letters immediately because they contain incorrect statements of
what the law is, namely: "It is important to note that VA has no legal
authority to pay a Veteran's cost shares, deductibles, or copayments
associated with their other health insurance."

And it is further ORDERED that within 45 days of the date of the order
the Secretary prepare and submit to the Court for approval a plan for
providing notice to veterans affected by the provision of notice that
contained an incorrect statement of the law concerning reimbursement
of costs for non-VA emergency care. (GREENBERG, ALLEN and
FALVEY) (Falvey, Judge, DISSENTING) (ARW)

See
Court Ruling 18-6091>>  View the 2019 Military Pay Charts ->
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Court rules VA must pay for veterans' emergency room care