How do I get medical treatment under the Defense Base Act?
In this article I discuss medical treatment under the Defense Base Act. I explain your rights to medical treatment under the DBA. I show you how to request medical treatment. And I give you a step by step guide on what you must do if the DBA insurance company refuses to provide you medical treatment and/or denies your medical treatment.
“When I seek out professional advice, I want honesty, I want frankness, I want advice straight-up, with no B.S. So should you.”
Defense Base Act Lawyer Bill Turley
When the Defense Base Act (DBA) was enacted into law in 1941, it was seen as important legislation to fill in the gaps for worker protection. Traditionally, state governments have always held the authority to require compensation for workers hurt on the job. But states didn’t have the reach to provide workman’s compensation—as it was called back then—for people working overseas.
The federal government had the authority, though, and used it. When passed into law, the DBA required businesses employing U.S. citizens for government contracts abroad to provide medical and income assistance benefits when those workers were injured on the job. Later amendments in the 1950s expanded the number of people covered. But the Defense Base Act has really enlarged since 2001, beginning with U.S. military action in Afghanistan. Thousands of civilian contractors have been hired for projects in the Middle East and adjoining areas, and the amount of DBA claims has skyrocketed due to the inherent dangers in the region.
The Scope of the Law
The Defense Base Act requires that contractors working for the U.S. government must provide workers’ compensation insurance for their employees who are hurt or killed overseas. Although one might first think of workers in the Middle East, in fact the scope of this law covers thousands of people worldwide, including civilians who…
- Work on U.S. military bases outside the United States; this includes bases located in foreign countries and also those in U.S. territories and possessions.
- Work overseas on federal projects that will transfer military services or equipment to U.S. allies as provided by the Mutual Security Act of 1954 or the Foreign Assistance Act of 1961.
- Work on public works projects for any federal agency.
- Work for American organizations that provide welfare or morale-building services to the U.S. Armed Forces overseas.
One of the core ideas behind the Defense Base Act is that working overseas is inherently riskier than similar jobs within the United States. For this reason, DBA rules differ from state workers’ compensation laws in one key way: workers are covered for injuries that happen when they are away from work, not just those that happen during work hours in the course of their duties.
When an eligible worker is hurt, the rules of the Defense Base Act apply. The worker’s employer, acting through the DBA insurance firm it has hired, is required to pay for the worker’s reasonable medical expenses and pay a portion of any wages the worker would have earned if he is too injured to work. The Defense Base Act provides no remedy for any other losses, such as pain or suffering. It does provide death benefits for surviving family members if the worker is killed overseas.
What are my rights to medical treatment under the Defense Base Act?
The Medical Benefits Provided Under the Defense Base Act
Although the income provisions of the Defense Base Act are certainly important, today we’ll be looking at the medical care benefits that the law provides.
The typical injury case will pass through three different phases of care. It’s useful to look at them separately.
Emergency medical care
In the aftermath of a sudden injury, the employee may not be able to select a specific doctor to treat his urgent needs. In that case, it’s the employer’s responsibility to see that the worker gets competent emergency care appropriate to his condition. If the employee is conscious, alert, and able to make his own decisions during a medical emergency, he may obtain the necessary medical care before requesting authorization from his employer.
Medical treatment phase
Before seeking treatment for his condition, the employee should inform his employer about the injury. He must also obtain a Request for Examination and/or Treatment form (Labor Department form LS-1); part of this form will be completed by the doctor providing his care.
The injured worker has the right to select any doctor he may wish to treat him, as long as that physician has been approved by the U.S. Labor Department. This is a huge difference from many the workers’ compensation programs available in many states. The chosen doctor will then guide the patient’s treatment for his injuries or illness, following reasonable medical protocols. This can include physical therapy, surgery, medication, medical tests and imaging, medical supplies, and provision of assistive devices such as crutches, wheelchairs, or prosthetics. Even reasonable transportation costs to visit the doctor will be compensated.
The employer or its DBA insurance company cannot force the worker to choose any specific medical providers. However, the insurance company does have the right to get a second opinion about the patient’s progress in recovering by scheduling an examination with a doctor it chooses. In addition, the Department of Labor can also insist on an independent evaluation from time to time.
If the patient wants to change doctors at some point in the future, he will have to seek permission from the insurance company.
There is no fixed time limit for the length of treatment. The patient can continue his medical care indefinitely, as long as progress is being made toward repairing the damage done by the employment injury or illness. The insurance company is required to pay for all treatment that is reasonable and necessary during this time.
Maximum medical improvement (MMI)
In the typical case, the patient will eventually reach a point where no additional progress can reasonably be expected. This is called the point of “maximum medical improvement.” At that point, the insurance carrier no longer has an obligation to pay for further new treatments. The insurance company will still be obligated to pay for medication or other ongoing treatments that sustain the patient at his current level of recovery.
It is a matter of medical judgment to decide when the patient has recovered as much as possible. Often, the insurance company will argue that the patient has reached peak improvement, but the patient will disagree. This can set the stage for a legal battle when the insurer tries to shut down medical benefits.
Lifelong medical treatment
This is not to suggest that you aren't entitled to medical treatment for the rest of your life under the DBA. You're entitled to medical treatment for the rest of your life under the DBA. You just have to show the medical treatment is reasonable and necessary.
What is the statute of limitations for Defense Base Act medical treatment?
The statute of limitations is how long you have to file a claim. Here is an article on the statute of limitations under the Defense Base Act.
Medical benefits are never time-barred. Siler v. Dillingham Ship Repair, 28 BRBS 38 (1994) (decision on recon. en banc); Ryan v. Alaska Constructors, Inc., 24 BRBS 65 (1990); Mayfield v. Atlantic & Gulf Stevedores. 16 BRBS 228 (1984). In Strachan Shipping Co. v. Hollis, 460 F.2d 1108, 1116 (5th Cir.), cert. denied, 409 U.S. 867 (1972).
Meaning, even if you have never filed a DBA claim, you can still obtain medical treatment for your overseas injury. Thus, there is no "statute of limitations" for medical treatment.
However, if you have a potential DBA claim. I suggest you file your "claim" as soon as possible. Because you might still be able to bring the claim. Do not wait - to it today. Bring the DBA claim (meaning file the claim with an LS-203). Then you protected (maybe) if you end up being entitled to disability benefits. And if not, you can still always get medical treatment. Because medical treatment under the DBA is never time-barred.
Why Your Medical Benefits May Be Denied or Terminated
In my experience, the main reason why DBA claimants (read: the overseas civilian contractor that is bringing a DBA claims) are denied medical benefits is because the DBA the insurance company is trying to save money (and boost its annual profits) by terminating your benefits too soon.
The greater danger is the insurance company’s arsenal of tricks to try to delay, deny, or cancel benefits. The insurance adjuster hopes that he can frustrate you into giving up your rights. His chief ally may be the “independent” doctor who was hired by the insurance company to form a second opinion about your condition; oddly enough, that opinion almost always favors shutting down your medical care.
The way this usually plays out is the DBA insurance company will schedule you an appointment to see their doctor. They will call it an "Independent Medical Examination. Which is really an insurance company doctor. The doctor will write a report which says that you don't need the medical treatment your doctor is requesting, that you're injuries are related to your being overseas, you're not really injured at all, you're really faking your injuries or exaggerating your injuries or all of the above.
Do I have to attend the medical examination scheduled by the DBA insurance company? .... You must attend the Defense Medical Examination
In spite of all this, you must attend the medical examination scheduled by the DBA insurance company. If you don't attend, you're DBA benefits will probably be stopped.
What is a free choice of physician under the Defense Base Act?
Under the DBA you are entitled to free choice physician. Basically, this means you get to choose who you get medical treatment from. However, you need to choose wisely, because if can be, at times, difficult to change physicians.
Your doctor can also refer you out to specialists and for testing when it is appropriate.
Beware - never do this!!!!
I strongly suggest that you never treat with a doctor chosen or recommended to you by the insurance company.
Why? Because the doctor is going to do what the DBA insurance company wants him or her to do. I have seen this too many times. It rarely ends well. The last thing you need is a doctor that's in the hip pocket of the DBA insurance company.
What if the Defense Base Act insurance carrier won't approve medical treatment? ...What should I do then?
What to do when the DBA insurance carrier won’t approve medical treatment....
When there are factual disputes as to the need for medical treatment under the DBA, the Judge is the one who has to resolve the dispute. Sanders v. Marine Terminals Corp., 31 BRBS 19 (1997).
Thus, if the DBA insurance carrier refuses to provide medical treatment, you should request a Telephonic Emergency Informal Conference (TEIC). As I explain in this article on TEIC’s, you are trying to get Recommendations from the DOL Claims Examiner which recommends the medical treatment.
Assuming the Recommendations for medical treatment are in your favor, and if the DBA insurance carrier agrees with the Recommendations - then you can either agree to the medical treatment with the DBA insurance carrier or the District director will be charged with choosing the treatment option.
If the Recommendations from the TEIC are not in your favor or the DBA insurance carrier refuses to follow the Recommendations, then you will need to file an LS-18 for a trial (read: a formal hearing).
The issue of whether medical treatment is necessary, where the parties disagree, is a factual matter within the administrative law judge’s authority to resolve. See Weikert v. Universal Maritime Service Corp., 36 BRBS 38 (2002); Sanders v. Marine Terminals Corp., 31 BRBS 19 (1997).
You Can Fight Back When Defense Base Act Medical Benefits Are Denied
Your medical benefits are your lifeline to a full recovery from the injuries you suffered while working overseas. You really cannot afford to let them go. At the first sign that the insurance company is trying to close off your benefits, go hire the best Defense Base Act lawyer you can find. Look for someone with deep experience fighting off insurance company obstructions—someone who knows insurer tricks and who isn’t afraid of the courtroom.
Be sure to claim your free copy of the 5 Star Book - Win Your Defense Base Act Case
This is an eye-opening book that gives you an insider's view of the Defense Base Act and how to beat the DBA insurance company. This book will take you step by step on how to avoid the DBA insurance company tricks and traps that are designed to destroy your DBA claim.
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Check out all of the 5 Star Reviews on amazon.com
5.0 out of 5 stars
Must buy for your self or someone you know dealing with a Defense Base Act case.
July 21, 2015
Most people loose their case before they even start. This was the harsh reality I was looking at when I was injured. The insurance company was ''acting' like my friend in an effort to have me included in the body of people represented by that 1st statement. This book has really shined a light on what I need to do to ensure I am following the rule of law and that I am able to understand and demand fair treatment from my insurance company. It is a rough and sometimes exhausting road but with this book as a guide I am so much more knowledgeable and prepared for the things being thrown at me.
5.0 out of 5 stars
DOD contractors must have excellent read!!!!! Linguist,translators must read.
July 28, 2015
If you are a former combat linguist/contractor that had to carry an AK-47 wear body armour and ride on afghan Pamir 2 stroke motorcycles in taliban I.E.D controlled afghanistan and got blown up by a roadside bomb I.E.D like myself then you will get all of your answers in this book. Thank you Mr.Turley for all the knowledge.
5.0 out of 5 stars
Turley did a great job,
April 2, 2016
I was not aware there was a books available for people that need help with the Defense Base Act Case. The book was very informative provide detailed information on what you need to do and how you need to do it to fill a claim, The book was well written, Mr. Turley did a great job,
The Judge vs. the District Director?
This article isn't legal advice
These discussions and/or examples are not legal advice. All legal situations are different. These testimonials, endorsements, photos and/or discussions do not constitute a guarantee, warranty, or prediction regarding the outcome of your legal matter, your particular case/ situation. Every case is different. There are any number of reasons why Defense Base Act cases are not won and/or are not as successful as one might hope.