Court of Appeals for Veterans Claims

CAVA says the VA must reimburse emergency medical expenses

By PVA National Staff

On September 9, the U.S. Court of Appeals for Veterans Claims (CAVC) struck down a VA regulation, finding it wrongly denied reimbursements to veterans who received emergency medical care at non-VA facilities, a decision that could result in payouts to veterans totaling billions. In an additional and unusual move in the case, Wolf v. Wilkie, the CAVC also certified a class action to cover these veterans, who incurred medical expenses that are not covered by private insurance for the emergency care at non-VA facilities.

This is the second time since 2016 that the court struck down VA regulations barring such payments, reaffirming that VA must step in as a “secondary payer” to prevent emergency medical expenses from being unfairly passed on to veterans when their non-VA health insurance doesn’t cover the full cost. In its decision, the CAVC noted, “Even after [our previous decision], 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 law the court is referring to is the Emergency Care Fairness Act of 2010, which amended 38 U.S.C. § 1725 to expand reimbursements to veterans for emergency care under certain circumstances. The regulation that the court struck down is 38 C.F.R. § 17.1005(a)(5).

While VA may still decide to appeal the ruling, any PVA member or veteran who has received emergency care in the community and had their claim for reimbursement denied, or has not filed a claim with VA for reimbursement, should contact a PVA National Service Officer for assistance.

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