Fed court reverses order for VA system overhaul
Legal Events
A federal appeals court on Monday reversed its demand that the Veterans Affairs Department dramatically overhaul its mental health care system.
A special 11-judge panel of the 9th U.S. Circuit Court of Appeals said that any such changes need to be ordered by Congress or the president.
The 10-1 ruling reversed an earlier decision by a three-judge panel of the same court.
The May 2011 ruling had ordered the VA to ensure that suicidal vets are seen immediately, among other changes. It found the VA's "unchecked incompetence" in handling the flood of post-traumatic stress disorder and other mental health claims was unconstitutional.
The new decision said courts are powerless to implement the fixes sought by two veterans groups that filed the lawsuit against the VA in 2007. The lawsuits alleged that hundreds of thousands of veterans had to wait an average of four years to fully receive the mental health benefits owed them.
"There can be no doubt that securing exemplary care for our nation's veterans is a moral imperative," Judge Jay Bybee wrote for the majority. "But Congress and the president are in far better position" to decide whether and what changes need to be done.
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.