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Your Rights to Medical Care Under the Defense Base Act


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.


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

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.


Why Your Medical Benefits May Be Denied or Terminated

In my experience, there are two reasons why you may be denied the benefits you deserve under the Defense Base Act: either your employer has violated the law and failed to buy the required insurance coverage, or 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.


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.

Learn more about the DBA, your medical benefits and what you need to do to win by getting a FREE copy of our book, Win Your Defense Base Act Case.



William Turley
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