TRICARE Recovery & Third Party Liability Guide

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## Quick answer In the TRICARE system, "recovery" refers to the medical and financial processes following an injury or illness, including rehabilitative care (physical, occupational, and speech therapy) and the legal process of Third Party Liability (TPL). TRICARE covers necessary clinical recovery services, but if your injury was caused by a third party—such as a car accident—the government is legally required to seek reimbursement from the at-fault party's insurance.

In detail

### Clinical Recovery: Rehabilitative Services TRICARE covers services intended to help you regain functional skills after an injury, surgery, or illness. These are primarily managed as outpatient benefits but can occur in inpatient rehabilitation facilities (IRFs).

* **Physical Therapy (PT):** Covered to improve mobility and relieve pain. Usually requires a referral from a Primary Care Manager (PCM) for Prime enrollees. * **Occupational Therapy (OT):** Covered to help you perform daily living activities (feeding, dressing, etc.). * **Speech Therapy:** Covered for conditions resulting from birth defects, disease, or injury. * **Applied Behavior Analysis (ABA):** Specific recovery and developmental support for those with Autism Spectrum Disorder (ASD).

### Financial Recovery: Third Party Liability (TPL) When TRICARE pays for medical care resulting from an accident (like a slip-and-fall or an auto wreck), the **Federal Medical Care Recovery Act** allows the government to recover those costs from the person or entity responsible.

* **The DD Form 2527:** If you receive care for an injury, you will likely receive this form in the mail. You must complete it to explain how the injury happened. * **Processing:** Humana Military (East) or TriWest Healthcare Alliance (West) will review the form to determine if a third party (like a car insurance company) should have paid the bill first. * **Impact on Benefits:** Your medical care is NOT withheld while this is sorted out, but failing to return the form can result in future claims associated with that injury being denied.

### Recovery Limits and Costs (2026 Rates) Costs vary based on your beneficiary group (Group A vs. Group B) and your specific plan.

*Note: 2026 costs for Group B Select retirees typically involve a small deductible followed by a fixed copay for specialty recovery visits.*

## Who this applies to * **Active Duty Service Members (ADSMs):** Recovery is coordinated through military hospitals (MTFs). ADSMs have $0 out-of-pocket costs for all authorized recovery services. * **Retirees and Families:** May use civilian networks for recovery but are subject to TPL recovery if an accident was caused by someone else. * **National Guard/Reserve:** Applies to those on active duty orders or those using TRICARE Reserve Select who are recovering from line-of-duty injuries.

Common scenarios

### Scenario 1: The Auto Accident (TPL) Jane, a TRICARE Select beneficiary, is hit by a distracted driver in 2026. TRICARE pays $15,000 for her initial surgery and physical therapy. TRICARE’s recovery contractor identifies the third-party liability and files a claim against the distracted driver’s insurance. Jane must complete DD Form 2527 to ensure the government can recover the $15,000 from the at-fault party's $50,000 settlement.

### Scenario 2: Post-Surgical Rehab Mark (TRICARE Prime, Group B) has knee replacement surgery in May 2026. His "recovery" involves 12 sessions of physical therapy. Because he is on Prime and sees a network provider with a PCM referral, his copay for these recovery sessions is $0 within the military system or a fixed network copay (approx. $25 in 2026) if referred to the civilian sector.

## Related terms * **Third Party Liability (TPL):** The legal obligation of an entity other than TRICARE to pay for medical expenses. * **DD Form 2527:** The Statement of Personal Injury-Possible Third Party Liability form. * **Subrogation:** The process by which an insurance provider (like TRICARE) seeks reimbursement from a third party. * **Habilitative Care:** Services that help a person keep, learn, or improve skills they didn't have (distinct from rehabilitative care, which "recovers" lost skills). * **Inpatient Rehabilitation Facility (IRF):** A specialized hospital or part of a hospital that provides intensive rehabilitation programs.

## Sources * **TRICARE.mil - Forms & Claims:** https://www.tricare.mil/FormsClaims/Forms/TPL * **Humana Military - Third Party Liability:** https://www.humanamilitary.com/provider/claims-and-billing/tpl * **TriWest Healthcare Alliance - Claims:** https://www.triwest.com/en/beneficiary/claims/ * **Defense Health Agency (DHA) - Recovery Operations:** https://health.mil/Military-Health-Topics/Business-Support/Legal-Services/Legal-Activities/Third-Party-Collection-Program