LESSON 2
MEDICAL AFFIRMATIVE CLAIMS
Section I. OVERVIEW
2-1.
INTRODUCTION
Since patients treated at military medical treatment facilities (MTF) are charged
nominal amounts, they are many times unaware of the true cost of medical care. The
actual cost to government is many times over the amount paid by the patient. When
patients are admitted to military MTFs for injuries caused by a third party, the government
has a means of recovering or collecting the cost of their care through medical affirmative
claims.
2-2.
DEFINITIONS
a. Injured Party. In military cases, an active duty or retired member of a
uniformed service, a family member of an active duty or retired member, or to any other
person who has been injured and is entitled to receive care at Government expense.
b. Tort. A wrongful act for which a civil action can be brought, except for one
involving a breech of contract.
c. Third Party. The prospective defendant, either a person or an agency, against
whom claim is made. Any department, agency, or instrumentality of the United States is
excluded as a prospective defendant for claims made by the U.S. Government. A claim
against a member or employee of the United States, or a family member of such member
or employee, will not be asserted unless the prospective defendant was guilty of willful
neglect or misconduct. A claim against a contractor with reimbursement by the United
States out of term of the contract will not be asserted without prior approval of the Judge
Advocate General.
d. Reasonable Cost. The amount actually expended by the Government in
providing medical care at any Army hospital or in a civilian facility. Charges are not made
in the case of a battle casualty or by the Army for the cost of care in another uniformed
service facility.
e. Medical Care. Care which includes, but is not necessarily limited to,
hospitalization, outpatient treatment, dental care, and prosthetic devices.
MD0755
2-2