Wolfe v. Wilkie*
On October 30, 2018, NVLSP filed a class action lawsuit in the U.S. Court of Appeals for Veterans Claims on behalf of veteran Amanda Wolfe. NVLSP asks the court in this lawsuit to overturn the thousands of VA decisions issued since January 9, 2018 that deny Ms. Wolfe and thousands of other veterans reimbursement of the emergency medical expenses they incurred in 2018 or before in a non-VA facility. All of these cases involve veterans who have insurance that covers some, but not all of the emergency medical expenses, and the VA denies reimbursement for the expenses that are not covered by the veteran’s insurance.
In pursuing this lawsuit, it would help NVLSP to know how the VA has handled other reimbursement claims when the veteran has insurance that covers some, but not all of the emergency medical expenses. To help NVLSP and to get information about whether this lawsuit may affect your claim for reimbursement, click here.
This is the second time that NVLSP has filed suit in the CAVC over VA’s failure to comply with the Emergency Care Fairness Act of 2010 (ECFA). In the first lawsuit, filed in 2014, NVLSP represented Richard Staab after the VA refused to reimburse him for any portion of the $48,000 he was billed for emergency open-heart surgery simply because secondary insurance covered part of the emergency care bill. That lawsuit resulted in the CAVC invalidating the VA regulation that prohibited reimbursement for any of the veteran’s emergency medical expenses simply because some, but not all of those expenses were covered by the veteran’s insurance. According to the CAVC, Congress intended the VA to step in as a “secondary payer” where other health care insurers cover only a portion of the cost of the veteran’s emergency treatment.
According to the class action filed today by Ms. Wolfe, the new hurdle violates the ECFA because that statute limits the scope of non-reimbursable expenses to only copayments or “similar payments.”
* On New Year's Day 2019, NVLSP filed a class action lawsuit in the U.S. Court of Appeals for Veterans Claims (CAVC) on behalf of of Peter E. Boerschinger. NVLSP accuses the U.S. Department of Veterans Affairs (VA) of sending false information throughout 2018 to tens of thousands of veterans who had applied for VA reimbursement of emergency medical expenses they incurred at non-VA facilities. The lawsuit asserts that the VA has a practice and policy of informing these veterans – falsely – that they cannot qualify for any reimbursement if they have partial coverage for their emergency medical expenses under a health plan contract. This VA representation is inaccurate, according to NVLSP, because it directly violates the binding decision issued by the CAVC in 2016 in Staab v. Shulkin, which invalidated a VA regulation because it prohibited reimbursement if the veteran had partial coverage under a health care plan. As part of Mr. Boerschinger’s lawsuit, NVLSP also seeks to compel the VA to provide corrected information to all veterans who received the inaccurate communications and to reinstate their reimbursement claims.
Background on Wolfe and Boerschinger v. Wilkie
01/02/19 Wolfe and Boerschinger v. Wilkie Amended Petition for Class Relief
Background Information on Wolfe v. Wilkie
10/30/18 Wolfe v. Wilkie Petition for Class Relief
10/30/18 NVLSP Again Sues VA Over Continued Refusal To Comply With the 2010 Statute Requiring VA To Reimburse Veterans For Emergency Medical Expenses Incurred At Non-VA Facilities