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ROLES AND ACTIONS IN ESTABLISHING MEDICAL AFFIRMATIVE
CLAIMS
a. DA Form 2985, Admission and Coding Information. (See figure 2-1.) This
form must be completed at the time of admission. It contains the diagnosis and all
available information about the incident, such as how it occurred, and when, where, and
what the person was doing at the time. If the person is able to come to the admission
office, obtaining this information is not a problem. However, when patients are admitted in
an emergency situation and bypass the admissions office, acquiring the needed
information is more difficult. In such cases, information must be obtained from police
(military or local), from the ambulance driver, from friends or relatives, or from whoever may
have the information. When a patient has been directly admitted as an injury case for
screening and determination, a DA Form 2985 must be forwarded to the Recovery Judge
Advocate (RJA) within three working days after his admission. The normal procedure for
the patient administrator is to hold all DA Forms 2985 pertaining to directly admitted injury
cases until completion of the entire day's transactions. Then, after the daily admission
sheet has been prepared and signed by the Patient Administrator, both are sent in one
package to the RJA in an expedient manner.
b. Recovery Judge Advocate (RJA). Refers to lawyer(s) who have been
assigned the responsibility for processing claims in the geographic area in which the initial
treatment or hospitalization occurs for an injured or diseased person entitled to medical
care at the Government's expense. The geographic area assigned to a particular RJA
generally corresponds to a geographic area assigned to an MTF. Normally, the RJA is the
judge advocate office furnishing legal services to the MTF where the initial treatment or
hospitalization was provided. Upon receipt of the DA Form 2985, the RJA investigates,
asserts, and to the extent of his authority, settles any claim arising out of the incident which
led to the injury, or he negates the existence of a claim.
c. Negated Claims. If upon investigation, the RJA denies the existence of a valid
claim, he dates and signs the DA Form 2985, and returns it to the originator with the
notation: "No third party liability." The negated claim, then, becomes a permanent part of
the inpatient treatment record.
d. Valid Claims. If the RJA finds that a valid claim exists, he documents it on the
DA Form 2985: "Possible Third Party Liability--DA Form 2631-R, Medical Care--Third
Party Liability Notification, required." He dates and signs the DA Form 2985 and returns it
to the originator. The patient administrator then places it in the inpatient treatment record.
When there is a valid claim, that is when the claim of third party liability has not been
negated by the RJA, the patient administrator must provide the RJA with three forms (DA
Forms 2985, 2631-R, and 3154) as well as a copy of all bills (hospital, physician's, etc.)
related to medical services rendered to persons eligible for medical care at Government
MD0755
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