VAFORMS.NET – VA Form 10-7959D – CHAMPVA Potential Liability Claim – The VA Form 10-7959D is the form you need to submit if you are claiming CHAMPVA’s potential liability based on a motor vehicle accident. It is also the form you should fill out if you are applying for the CHAMPVA benefit for an unused or expired driver’s license. If you are not sure about how to fill out the form, you can use the information below to learn more.
Download VA Form 10-7959D – CHAMPVA Potential Liability Claim
| Form Number | VA Form 10-7959D |
| Form Title | CHAMPVA Potential Liability Claim |
| Edition Date | Oct 2021 |
| File Size | 748 KB |
What is a VA Form 10-7959D?
VA Form 10-7959D is a form that is used in the United States. It is a legal document that provides basic information to determine third-party liability. The form is a part of the Civilian Health and Medical Program of the Department of Veterans Affairs. This program is governed by 38 USC 501 and 1781.
Applicants for the CHAMPVA benefits must complete the form. This is a mandatory process, and failure to complete the form may delay the request for benefits. Those who are eligible for the benefits must fill out the form and provide a social security number. Upon receipt of this form, the VA will determine the service-connected disability and assess whether the applicant is eligible to receive CHAMPVA benefits.
The form can be completed in seven minutes or less. If you are unable to fill out the form, it can be downloaded from the VA’s website. Once you have downloaded the form, you can view and edit it with the toolbar. Editing features include the ability to add or remove text, pictures, symbols, and checkmarks.
For a veteran to be eligible for CHAMPVA benefits, he or she must have received the requisite medical care or services during wartime, or while the Veteran was in a VA facility. A veteran’s dependents can also receive these benefits. These beneficiaries must be unmarried, under the age of 18, and permanently incapable of self-support.
Where Can I Find a VA Form 10-7959D?
The Veterans Health Administration’s (VHA) Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program that provides health care to eligible family members. This includes spouses, children, and other beneficiaries of Veterans. In order to access the benefits, applicants need to meet certain eligibility requirements, such as being a surviving spouse or a child of a veteran. VA Form 10-7959D – or the VA’s Medical Benefits Package – is one of the many forms that you will need to fill out.
Fortunately, the process is not difficult to follow. Applicants must first declare other types of insurance, such as a Medicare plan or other non-VA medical coverage. Once the information is submitted, the VA will send you an enrollment letter informing you of your Priority Group assignment, your copay, and other relevant details. While most applicants remain enrolled without action, you should follow the instructions in your enrollment letter to make sure you get the maximum benefit.
If you are still unsure about what VA Form 10-7959D is all about, you can check out the VA website for more information. You may also want to consult your state department of veterans affairs to see what kind of assistance you can get.
VA Form 10-7959D – CHAMPVA Potential Liability Claim
Champva is a program run by the US Department of Veterans Affairs to provide medical services to wounded or ill veterans and their families. There are certain requirements you must meet to qualify for the program. These requirements include having served at least 90 days as a member of the military and being either a surviving spouse or a child of a veteran.
In order to receive these benefits you must complete a Champva claim VA Form 10 7959A. The form is available online. It should be completed by the applicant, sponsor, and beneficiary. Applicants should be prepared to provide copies of any documents that are submitted with the application.
Applicants also must report any changes in their non-VA health insurance, as well as any new beneficiaries. They should also be prepared to provide an itemized bill. Items like copayments, insurance information, and physician details should be provided. If they fail to do so, they may be denied the benefits they need.
There are several other VA forms you should be familiar with. These are used to report possible violations of law, coordinate benefits, and obtain OHI information. You should also be aware that information on these forms can be released to other agencies without your consent. For example, you might be surprised to find that your VA may release information on malpractice claims and adverse actions.
VA Form 10-7959D Example
