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Military Medical Standards of Care Overseas: Foreign Claims Process

Understand the process, laws, and common issues related to medical claims involving US Health Care Providers overseas, including proper claimants, filing, investigations, and exclusions. Learn about liability, standard of care, and cultural considerations through sample cases. Find relevant references for handling medical claims abroad.

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Military Medical Standards of Care Overseas: Foreign Claims Process

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  1. Medical Standard of Care in the Foreign Claims Arena Douglas A. Dribben Foreign Torts Branch US Army Claims Service 4 March 2008

  2. Agenda • Introduction • Law • Process • Common Issues • Where to Turn? • References

  3. Introduction • US Health Care Providers (HCPs) in military medical facilities overseas. • Bad results happen to good people • Medicine is not perfect • Greater awareness of claims

  4. Law • Military Claims Act, 10 USC 2733 • Foreign Claims Act, 10 USC 2734 • International Agreement Claims Act, 10 USC 2734a • Status of Forces and other agreements • DODD 5515.8 – SSR • 10 USC §1089(f)

  5. Process • Proper claimants • Proper filing • SOL • Exclusions • Investigation • Adjudication

  6. Proper Claimants • Patients • Feres/Incident to Service • Pregnant soldiers • Family members • Estates/guardians

  7. Proper Filing • Sum Certain • Properly signed • In writing* • Sufficient facts • Statute of Limitations • US v. Kubrick, 444 US 111 (1979)

  8. Exclusions • SOFA • Statute of limitations • Another Statute Takes Precedence • Workers Compensation • Vaccine claims • Constitutional torts • Assault/battery* • Libel, misrepresentation

  9. Investigation

  10. Claim Investigations • Personnel: CJA/MCI • PCE vs. claim • Sequester medical records/ notes/imagery • Review medical records – DO NOT ALTER • Make MFR of recollection of case once notified

  11. Claim Investigations • Interview • Explain medical terms and abbreviations • QA/RM • Submissions • Opinion • Review MFR

  12. Claim Investigations • Assist MCI in focusing medical issues • Standard of Care • MCA – American • FCA – American? • SOFA – Host nation in scope – recent case – host nation?

  13. Liability • Loss of Chance • Burden of Proof • Compromise • SOFA award • Legal vs. factual reasons

  14. Common Issues • What law applies? • What standard of care? • Language issues? • Use of local national HCPs • Medical records translation and quality • Cultural issues

  15. Sample Cases • Recently married dependent spouse presents to ED with GI complaints. • Language difficulties • Cultural difficulties • At ED • On ward

  16. Sample Cases • Dependent spouse gives birth in contracted local national hospital. • US HCP accompanies, provides history, hands off patient; no further care • Allegations – MOU and history negligent

  17. Sample Cases • Retiree presents with CD from local national HCP of colonoscopy and suspicious polyp, but no biopsy. • US HCP uses CD, operates – normal fold • Issue – reliance on local national report

  18. Sample Cases • Local national civilian presents as emergency GI case. • No evidence re: previous history or treatment • Previous/follow-on care in local national hospital • SOC – local? US?

  19. Where to Turn? • MCJA office • Servicing OSJA • Command Claims Services • USARCS FTB • MEDCOM OSJA

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