The short answer
After a car accident or other injury someone else may be responsible for, bill that insurance first, whether it's yours or the other person's. Once it sends an explanation of benefits, CHAMPVA may pay the remaining covered balance. VA may also send Form 10-7959D asking about the accident, because federal law lets VA recover its costs from whoever is responsible.
Who pays first after an accident?
The CHAMPVA Guidebook says that after an accident, you or the provider must first file with your insurance or the other person's insurance. VA calls this third-party liability. After that insurer sends its EOB, you can send CHAMPVA the remaining balance.
This can apply to:
- car accidents (your auto insurer or theirs),
- falls or injuries on someone else's property (homeowner or business insurance), and
- other events where someone else may be at fault.
Work injuries follow different rules. More here: CHAMPVA and workers' compensation.
What should you do?
- Tell every provider the care is accident-related and give them the accident insurance information along with your CHAMPVA card.
- Have the accident insurer process the medical bills first.
- Keep its EOB or payment decision.
- Send CHAMPVA the remaining covered balance with that EOB.
- Answer VA if it asks for accident information.
- Keep everything together: claim numbers, EOBs, itemized bills, receipts, and any police or incident report.
The other insurer's EOB doesn't make a non-covered service covered by CHAMPVA.
What is Form 10-7959D?
VA Form 10-7959D, the CHAMPVA Potential Liability Claim. VA may send it when a claim looks injury-related. It asks for:
- the diagnosis,
- when, where, and how the injury happened,
- whether it was at work, home, in a car, or elsewhere,
- witnesses or investigators,
- the insurance company or employer and policy number, and
- your attorney, if you have one or are considering one.
It isn't the regular claim form (that's 10-7959a), and getting it doesn't mean your claim was denied. But the form says leaving out information can delay or lead to denial of benefits.
Why does VA want this?
38 CFR 17.278 says VA pursues recovery of its medical costs. The Federal Medical Care Recovery Act gives the government a right to recover the reasonable value of care it paid for when someone else is legally responsible for the injury.
In plain terms: CHAMPVA paying your bills doesn't let the responsible party off the hook. VA may collect from them or their insurer.
If you have an attorney for the accident, tell them CHAMPVA is paying medical bills, and give VA the attorney's information.
How do you file the CHAMPVA part?
Usually the provider files. If you paid yourself, file online or with VA Form 10-7959a, with:
- proof of payment,
- an itemized bill, and
- the accident insurer's EOB.
File within 1 year of the care, or 1 year from discharge for a hospital stay. Don't let the accident claim run out your CHAMPVA deadline. More here: CHAMPVA claim filing deadlines.
Checklist
- Identified the responsible insurance
- That insurer processed the medical bills first
- Saved its EOB
- Kept itemized bills and receipts
- Filed the remaining balance with CHAMPVA
- Returned Form 10-7959D if VA asked
- Gave VA your attorney's information, if you have one