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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.
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