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Sample NAVJAG Form 5890/12, Report of Hospital and Medical Care—Third Party Liability, Supplemental Statement (back) - 14134_341
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Sample NAVCOMPT Form 372, Allotment/Suballotment Authorization - 14134_343
incurred by the policyholder, his or her passengers who are riding in the insured vehicle, or a pedestrian who is struck by the insured vehicle. Assuming such coverage exists (and it is the claims officer’s responsibility to determine  if  it  does),  medical  payments  clauses  apply regardless of who was at fault and the United States may be entitled to recover as the provider of medical care. It is extremely important to note that recovery has been allowed,  based  on  one  of  two  theories:  (1)  that  the United  States  is  insured  under  the  medical  pay provisions of the insurance policy or (2) that the United States is a third-party beneficiary of the insurance contract. Recovery is not based upon the MCRA, but under the terms of the individual insurance policy. UNINSURED  MOTORIST  COVERAGE Another potential source of recovery of medical care costs is the uninsured motorist coverage provisions of  the  typical  automobile  insurance  policy.  If  an  injured service member has obtained such coverage, and the tortfeasor is uninsured, the typical uninsured motorist coverage  clause  provides  for  payment  to  the policyholder  of  those  sums  that  he  or  she  would  have been able to recover from the tortfeasor, but for the fact that  the  tortfeasor  was  uninsured. Like  medical payments  insurance  coverage,  the  right  of  the  United States to recover is based upon the terms of the insurance contract and not upon the MCRA. If the term  insured includes any person, then the courts have generally held that the United States is entitled to recover. NO-FAULT  STATUTES The recovery of the United States under the MCRA in states that have enacted no-fault statutes will be determined  by  the  language  of  the  statute.  It  is necessary to determine if the United States is within the terms of the statute so as to be entitled to recover for medical care provided. If the state statute eliminates a cause of action against the tortfeasor, then the only probable source of recovery is under the injured party’s no-fault insurance. If the United States is excluded and has no cause of action, then there maybe no recovery in the particular case. AFFIRMATIVE  CLAIMS  AGAINST SERVICE  MEMBER  TORTFEASER The United States may not assert an affirmative claim against a service member or employee who,  while in  the  scope  of  employment,  damages  government property  or  causes  damage  or  injury  for  which  the United States must pay. Consideration, in the case of gross negligence or willful and wanton acts, should be given to whether such actions took the service member or  employee  outside  the  scope  of  employment. CLAIMS MANAGEMENT As  a  senior  LN,  your  knowledge  in  claims accounting procedures must be thorough. You need to be familiar with the many budget projects out of which claims  are  paid.  The  following  will  present  an  overview of how to manage a claims accounting system. MANAGING NAVY CLAIMS FUNDS Managing claims funds should be no more difficult than  taking  care  of  a  checking  account.  Checks (vouchers)  and  deposits  (case  collection  vouchers  and fund  authorizations)  arc  recorded  in  a  checkbook (memorandum   accounting   logbook).   They   are processed  by  a  bank  (accounting  activity)  which  then sends out bank statements (accounting reports). These are used to reconcile what actually has been recorded by the bank (accounting activity) against what should have been   recorded   as   indicated   in   your   checkbook (memorandum accounting logbook). While the bank statement  is  usually  correct  and  reconciliation  can  be delayed, the accounting reports must be reconciled each month due to the possibility of input error or missing documents. Therefore, you must reconcile monthly with  authorization  accounting  activities. FUND AUTHORIZATIONS All funds are issued on a NAVCOMPT Form 372, Allotment/Suballotment  Authorization  (fig.  12-6),  by budget  project.  Budget  project  10  authorizes  funds  to pay NATO/SOFA claims; budget project 11 authorizes funds to pay federal tort claims; budget project 12 authorizes funds to pay military claims; and budget project 13 authorizes funds to pay personnel claims. If necessary and as long as JAG is notified immediately, funds  can  be  transferred  between  budget  projects. The  fiscal  year  runs  from  1  October  to  30 September. After  the  initial  authorization  at  the beginning of the fiscal year, additional funds will be authorized  at  the  beginning  of  each  succeeding  quarter and upon request. When funds are issued by message or telephone, obligation can be made before the actual receipt of the NAVCOMPT Form 372. For the first three quarters of the fiscal year, fund balances maybe carried forward from one quarter to the next,  but the end-of-year  balances  cannot  be  carried  forward  to  the next fiscal year. 12-34

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