Does Tricare get a piece of car-crash settlement?
November 5th, 2009 | TriCare Help | Posted by Military Times
Q. My wife was hurt in a car accident. Tricare paid her medical bills, like it is supposed to. The other driver’s insurance has offered to settle with my wife, but our lawyer says Tricare wants her to use the settlement to repay what it spent on her medical bills. That is unfair. My wife is the one who got hurt, so it is her money. I already paid for Tricare with my military service. If it wants money, Tricare should go to the insurance company for it like we did. Is it legal for Tricare to get a free ride at my wife’s expense?
According to your letter, Tricare has already done for your wife all the things it is supposed to do. It has paid all of the claims for her medical care. If your wife has paid her cost shares and any deductibles on the claims, according to the Explanation of Benefits forms she has received from Tricare, she has no providers demanding payment. Her bills were paid in full.
Your question now concerns legal matters, and I am not a lawyer. While I can tell you what a law says, or you can read the law yourself; I am not qualified to interpret a law or to say how it applies to a given individual or situation.
This reply is based on what I learned when I worked for the Pentagon’s Office of Health Affairs and things I have read after that. You should take no action or make any decisions based on what I tell you — seek guidance from your lawyer. If he has questions, he can write to the Office of General Counsel, Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043.
According to your letter, because the other driver caused the accident, he was responsible for paying for the resulting damages, including your wife’s medical bills. His insurance company became a third party in the case; on his behalf, it became liable for paying at least part of the costs of restoring your wife to the condition she was in before the accident — what lawyers refer to as “making her whole.” Whether it does is a legal matter and out of my purview.
Federal law requires Tricare to try to recover, from a liable third party, the reasonable costs of the medical care Tricare paid for.
That is a matter between Tricare and the insurance company; your wife is not involved in Tricare’s recovery efforts. Even if Tricare is unable to recover the full amount, your wife will not be held liable to pay any remaining amount.
In my experience, the amount due to Tricare under federal law will be withheld from the insurance settlement before any funds are released to your wife. Presumably, part of the settlement has never been hers alone. The amount remaining after Tricare recovers its part will be hers to keep.