4 DEC 1991
a. Beneficiary: Includes all active duty and retired personnel, and their dependents,
eligible for medical care at the expense of the Federal government. Beneficiaries
also include Coast Guard reserve personnel on active duty for training or inactive
duty training, and Coast Guard Auxiliary personnel performing duty or traveling
under official government orders.
b. Third Party: The term Third Party describes any person or organization deemed
liable, due to a negligent or intentional act, for the cost of medical or dental care
provided to a beneficiary.
c. Third Party Liability Claim: This is the action initiated by the Coast Guard to
recover from a third party the cost of certain medical or dental care. A third party
liability claim may be initiated when an incident involves inpatient or outpatient
medical/dental treatment of a beneficiary at Government expense (or at a Federal
facility) for an injury, illness, or disease that either:
(1) may have been caused by the negligent or intentional act or omission of a
third party; or
(2) may be covered by an insurer with or without regard to fault, for example,
workers' compensation, "no fault" insurance, or another health care policy
that is the primary payer, such as a Health Maintenance Organization.
d. Settlement Authority: Refers to a person authorized to settle a claim. Reference (a)
designates Commandant (G-L) as the settlement authority for third party liability
claims involving recovery of health care funds for the Coast Guard.
EXAMPLES. The following are practical examples of situations with potential third party
a. A service member and the member's dependent are injured in a car accident caused
by another driver. The member is treated at a military health care facility, and the
dependent, treated by a civilian provider, files a CHAMPUS claim. The Federal
government should assert a third party liability claim for the cost of medical/dental
services rendered at the military facility, and for the Federal government's share of
the CHAMPUS payment made to the civilian provider.