\nI hereby certify that this claim meets all of the conditions for payment\n -----------------------------------\nfor payment of such transportation; and the veteran has no contractual \nor legal recourse against a third party that could reasonably be \npursued for the purpose of extinguishing, in whole or in part, the \nveteran's liability to the provider.\n \n(Authority: 38 U.S.C. 1725)\n Signature\n \n \n38 CFR 17.1002 Substantive conditions for payment or reimbursement.\n--------------------------------------------------------------------\n Payment or reimbursement under 38 U.S.C. 1725 for emergency \nservices may be made only if all of the following conditions are met:\n (a) The emergency services were provided in a hospital emergency \ndepartment or a similar facility held out as providing emergency care \nby VA for emergency medical services under 38 CFR 17.1002 and 17.1003.\nto the public;\n (b) The claim for payment or reimbursement for the initial \nevaluation and treatment is for a condition of such a nature that a \nprudent layperson would have reasonably expected that delay in seeking \nimmediate medical attention would have been hazardous to life or health \n(this standard would be met if there were an emergency medical \ncondition manifesting itself by acute symptoms of sufficient severity \n(including severe pain) that a prudent layperson who possesses an \naverage knowledge of health and medicine could reasonably expect the \nabsence of immediate medical attention to result in placing the health \nI am aware that 38 CFR U.S.C. 6102(b) provides that one who obtains\nof the individual in serious jeopardy, serious impairment to bodily \nfunctions, or serious dysfunction of any bodily organ or part);\n (c) A VA or other Federal facility/provider was not feasibly \navailable and an attempt to use them beforehand would not have been \nconsidered reasonable by a prudent layperson (as an example, these \nconditions would be met by evidence establishing that a veteran was \nbrought to a hospital in an ambulance and the ambulance personnel \ndetermined that the nearest available appropriate level of care was at \na non-VA medical center);\n (d) The claim for payment or reimbursement for any medical care \npayment without being entitled to it and with intent to defraud the\nbeyond the initial emergency evaluation and treatment is for a \ncontinued medical emergency of such a nature that the veteran could not \nhave been safely transferred to a VA or other Federal facility (the \nmedical emergency lasts only until the time the veteran becomes \nstabilized);\n (e) At the time the emergency treatment was furnished, the veteran \nwas enrolled in the VA health care system and had received medical \nservices under authority of 38 U.S.C. chapter 17 within the 24-month \nperiod preceding the furnishing of such emergency treatment;\n (f) The veteran is financially liable to the provider of emergency \nUnited States shall be fined in accordance with Title 18, United States\ntreatment for that treatment;\n (g) The veteran has no coverage under a health-plan contract for \npayment or reimbursement, in whole or in part, for the emergency \ntreatment (this condition cannot be met if the veteran has coverage \nunder a health-plan contract but payment is barred because of a failure \nby the veteran or the provider to comply with the provisions of that \nhealth-plan contract, e.g., failure to submit a bill or medical records \nwithin specified time limits, or failure to exhaust appeals of the \ndenial of payment);\n (h) If the condition for which the emergency treatment was \nCode, or imprisoned not more than one year, or both.\nfurnished was caused by an accident or work-related injury, the \nclaimant has exhausted without success all claims and remedies \nreasonably available to the veteran or provider against a third party \nfor payment of such treatment; and the veteran has no contractual or \nlegal recourse against a third party that could reasonably be pursued \nfor the purpose of extinguishing, in whole or in part, the veteran's \nliability to the provider; and\n (i) The veteran is not eligible for reimbursement under 38 U.S.C. \n1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA \npayment or reimbursement for emergency treatment to a limited group of \n \nveterans, primarily those who receive emergency treatment for a \nservice-connected disability).\n \n(Authority: 38 U.S.C. 1725)\n \n \n38 CFR 17.1003 Emergency transportation.\n-----------------------------------------\n Notwithstanding the provisions of Sec. 17.1002, payment or \nreimbursement under 38 U.S.C. 1725 for ambulance services, including \n \nair ambulance services, may be made for transporting a veteran to a \nfacility only if the following conditions are met:\n (a) Payment or reimbursement is authorized under 38 U.S.C. 1725 for \nemergency treatment provided at such facility (or payment or \nreimbursement could have been authorized under 38 U.S.C. 1725 for \nemergency treatment if death had not occurred before emergency \ntreatment could be provided);\n (b) The veteran is financially liable to the provider of the \nemergency transportation;\n (c) The veteran has no coverage under a health-plan contract for \n \nreimbursement or payment, in whole or in part, for the emergency \ntransportation or any emergency treatment authorized under 38 U.S.C. \n1728 (this condition is not met if the veteran has coverage under a \nhealth-plan contract but payment is barred because of a failure by the \nveteran or the provider to comply with the provisions of that health-\nplan contract); and\n (d) If the condition for which the emergency transportation was \nfurnished was caused by an accident or work-related injury, the \nclaimant has exhausted without success all claims and remedies \nreasonably available to the veteran or provider against a third party \n
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