Understanding TRICARE and Personal Injury Claims

Research shows that military personnel covered by the TRICARE system face an excessive rate of personal injuries, making up about 5 million medical visits per year across all six branches (1). At the Law Office of William Bruzzo, we understand that dealing with a personal injury is overwhelming and frustrating. Dealing with the military’s TRICARE medical system can be even more confusing and stressful. Our legal team handles many personal injury claims involving the TRICARE system, and we can guide you through the entire process from A to Z. It won’t cost you anything to reach out to an Orange County military injury lawyer and ask a few questions, learn your rights, and pursue legal action.

What is TRICARE?

TRICARE, or Total Resource Information and Control for the Environment, is the Department of Defense’s medical insurance program that provides coverage for military personnel and their families. It offers various types of care, including health care, dental care, pharmacy services, mental health care, reproductive health, special needs, and vision. TRICARE aims to ensure that those serving in the military and their family members have access to quality medical care. Finally, injuries, not illnesses or diseases, are indeed the primary reason active duty military members come to Tricare for treatment.

TRICARE Eligibility and Claims Process

Unfortunately, some TRICARE beneficiaries experience issues with their eligibility due to data transfer problems. If you have been dropped from DEERS (Defense Enrollment Eligibility Reporting System) and believe that your TRICARE eligibility has been affected, contact the DMDC/DEERS Support Office to confirm your eligibility. They will provide you with the necessary steps to resolve the issue and regain your TRICARE coverage.

When it comes to filing claims for medical, pharmacy, dental, and third-party liability, you must follow specific guidelines and timeframes. Providers will typically file medical claims on your behalf, but there are situations where individuals need to file their own claim—this is where a tried-and-true Orange County military injury lawyer comes in handy. Nevertheless, make sure to reach out to the appropriate regional contractor for specific claim processing instructions. Military medical claims must be filed within certain time frames depending on your location. Ask your attorney.

TRICARE Coverage and Personal Injury Claims

If you are involved in an accident on or off base and require medical care, TRICARE will cover your injury-related bills. However, you will still be responsible for copays and non-covered services. TRICARE has the right to seek reimbursement for the medical expenses they paid in the event of a personal injury settlement you may receive, so please keep this in mind. To reiterate, this means that if someone else caused the accident, TRICARE can recover its costs for treating you.

Note that TRICARE also uses liens to ensure they are compensated if you file a personal injury case. TRICARE can automatically “attach” onto your settlement, and they are not required to send any notice whatsoever. These liens can affect the disbursement of your settlement proceeds, and there is no cap on the amount TRICARE can receive. However, a reputable, reliable Orange County military injury lawyer can negotiate and reduce TRICARE liens based on fairness and undue hardship. When filing a personal injury claim in the military, you want to work with an attorney who understands TRICARE’s requirements regarding medical liens. At the Law Office of William Bruzzo, we have extensive experience in handling personal injury claims involving TRICARE. 

Understanding Third Party Liability

In some cases, injuries may be caused by someone else’s actions or negligence. TRICARE can be reimbursed for the costs of treating injuries caused by someone else through a process known as third-party liability. If you are a TRICARE beneficiary and have been injured due to someone else’s actions, you may receive a Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) from your regional contractor. Complete and return this form within 35 calendar days to ensure that TRICARE can seek reimbursement for the expenses incurred in treating your injuries. Again, TRICARE does not exclude cost-sharing based on the source of an injury, and they have the right to demand full repayment for covered expenses.

7 Steps for Filing a TRICARE Personal Injury Claim

As an Orange County military injury attorney, here are the steps we recommend you take to ensure that you receive the compensation you deserve:

• Get Medical Treatment: Your health and well-being should always be your top priority. Make sure to document all medical treatment related to your injury, including doctors’ visits, hospital stays, and any necessary tests or procedures. This documentation will be the foundation for filing your TRICARE personal injury claim.
• Report the Incident: Next, you must report the incident to the appropriate authorities. This could include the military police or your commanding officer, depending on the circumstances. Reporting the incident promptly will help establish a record of the event and ensure that your claim is taken seriously.
• Collect Evidence: To support your claim, gather as much evidence as possible. This includes photographs of the accident scene, witness statements, and any other relevant documentation. The more evidence you have, the stronger your claim will be.
• Speak to an Orange County Military Injury Lawyer: While, yes, TRICARE provides coverage for personal injury claims, their process is complex and overwhelming. That’s why it’s beneficial to contact a lawyer who can guide you through the process and ensure that your rights are protected. 
• File Your Claim: Once you have gathered all the necessary documentation and hired an attorney, then you’ll file your TRICARE personal injury claim. This can typically be done online or by mailing the necessary forms and supporting documents to the TRICARE claims office. Be sure to include all the necessary information and documentation to avoid delays in processing your claim.
• Cooperate with the TRICARE Investigation: After filing your claim, the TRICARE claims office will conduct an investigation to determine the validity and extent of your injuries. Cooperate fully with this process, providing any additional information or documentation that may be requested. Again, your attorney can help you through the investigation and ensure your rights are protected.

Your Experienced Orange County Military Injury Lawyer

If you are in Orange County and need assistance with a personal injury claim involving TRICARE, the Law Office of William Bruzzo can make the process faster, less stressful, and more efficient. Our legal team is well-versed in military personal injury claims and has vast knowledge in handling TRICARE’s rules and red tape. Contact our office now to schedule a free consultation and case review with an Orange County military injury lawyer now.