Handling Misfiled Claims VFW Basic Training

Preventing and Handling Misfiled Claims VFW Basic Training September 2021 Michael Figlioli Deputy Director National Veterans Service MFiglioli@vfw.org

Topics of Discussion What is a misfiled claim? Preventing Misfiled Claims Representatives Responsibilities for Misfiled claims NVS Procedures for Misfiled Claims 2

What is a misfiled claim? For VFW NVS purposes, a misfiled claim is the untimely submission of VA paperwork by an accredited representative resulting in a loss of monetary benefits. The VA paperwork must have been submitted timely by the claimant to the VFW accredited representative. 3

What is a misfiled claim? Claim Effective Dates: Generally, the effective date of the claim will be the date of receipt of the claim, or the date entitlement arose, whichever is the later. 38 CFR 3.400 Intent to File (ITF) If VA receives a complete claim within 1 year of the filing of an ITF, the claim will be considered filed as of the date of receipt of the ITF. 38 CFR 3.155(d)(1) **Note** An ITF will not preserve an effective date of a supplemental claim Transitioning Service Members Day following separation if claim is received within 1 year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. 38 CFR 3.400(b)(2) 4

What is a misfiled claim? Timely Legacy Appeals: Notice of Disagreement (21-0958) a Notice of Disagreement must be filed within one year from the date that that agency mails notice of the determination. 38 CFR 20.302(a) Substantive Appeal (Form 9) a Substantive Appeal must be filed within 60 days from the date that the agency of original jurisdiction mails the Statement of the Case to the appellant, or within the remainder of the 1-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 CFR 20.302(b) 5

What is a misfiled claim? Timely New Appeals: Higher Level Review (20-0996) a HLR Form must be filed within one year from the date that that agency mails a notice of the determination. 38 CFR 3.2601(d) Supplemental Claim (20-0995) a supplemental claim along with new and relevant evidence must be filed within one year from the date that that agency mails notice of the determination to protect the original claim effective date. 38 CFR 3.2500 Board of Veterans Appeals Notice of Disagreement (10182) a properly completed Notice of Disagreement must be filed within one year from the date that the agency mails the notice of the decision. 38 CFR 20.203(b) 6

What is a misfiled claim? Date of receipt of claim is the date VA receives the claim. NOT the date the paperwork is received by the veteran service organization (even if the VSO is located within a VARO)! 7

What is a misfiled claim? Name some examples of how these can become misfiled claims: Intent to File Standard Compensation Claim Notice of Disagreement Supplemental Claim Transitioning Service Member Compensation Claim 8

Preventing misfiled claims The following office practices should be used to prevent misfiled claims from occurring: Finish ALL claims paperwork with a veteran prior to assisting the following veteran (complete & submit forms immediately). Triage correspondences from veterans immediately (do not wait until the end of the month to OPEN mail and/or emails as there may be Transitioning Service Member Claims, NODs, & Form 9s which might be time sensitive) If your office closes due to unforeseen circumstances, ensure that all correspondence to the office is still addressed and that outgoing messages inform your clients of your current working situation and policies for submitting items to the office and VA 9

Preventing misfiled claims Office practices continued: Maintain digital office logs (office visits & incoming claimant mail and faxes) Document phone calls & emails within Vetraspec (or other claims management system) Retain proof of all submissions (date stamped copies, fax confirmations, etc.) 10

Preventing misfiled claims - Outreach During outreach events, veterans will often ask you to submit items to VA on their behalf. The following practices should be used to prevent misfiled claims: Coordinate with the event organizer to determine if you will have access to an internet connection and electrical power; if so, bring your laptop and signature pad to the event. If possible, bring a scanner so that you can upload and submit documents immediately and reduce the risk of losing paperwork in transport. Keep an accurate log of who you met with during the event. Ensure that all paperwork is secure and accounted for at all times especially while transporting. 11

Preventing Misfiled Claims Proof of Submission It is extremely important keep proof of ALL submissions to the VA in the VetraSpec database, including copies of the completed and signed forms. This practice allows us to safeguard the veteran s effective date which is an essential part of representing and advocating for veterans and their families. If VA were to lose a document, misrepresent an effective date, or otherwise neglect a veteran s file, accurate records in VetraSpec will allow us to quickly and easily correct the error and preserve the veteran s benefits. 12

Preventing Misfiled Claims Proof of Submission D2D: VetraSpec automatically logs the submission proof in the Package This Claim section, but check the submission to ensure that it was successful Direct Submit: Once the submission reaches Received status, the effective date is preserved, however you must continue to check the status in VetraSpec to ensure that the submission was successful Centralized Mail Portal: Submissions through the CMP are given a confirmation number on the screen and in your email that needs to be copied into the Communications page in VetraSpec SEP: Once uploaded, snip a screenshot of the page and upload it to the Documents section in VetraSpec Fax: You will receive a confirmation fax from the VA upon successful transmission. Upload this page into the Documents section in VetraSpec Direct Mail in the VARO: Request a date stamped copy of the submission and upload it to the Documents section of VetraSpec 13

Preventing Misfiled Claims Proof of Submission Keeping proof of submissions to VA protects both you and the veteran if something goes missing 14

Representatives Responsibilities Upon identifying a potential misfiled claim/untimely submission of VA paperwork: Immediately notify office supervisor Office supervisor will in turn notify Department Adjutant & NVS Annotate details of the occurrence within Vetraspec Type of paperwork & method of submission from claimant to office When was the paperwork submitted by claimant to VSO When was the paperwork submitted by VSO to VA Previous VA Rating & New VA Rating (if applicable) Upload ALL pertinent documents into Vetraspec 15

Representatives Responsibilities Upon being contacted by a claimant seeking damages from VFW due to an untimely submission of a claim: Notify office supervisor, Department Adjutant, & NVS Instruct claimant to contact NVS Do NOT: Conceal the occurrence of the untimely submission Purge any documents Terminate POA Encourage claimant to appeal effective date (on the grounds of the untimely submission alone) Solicit corrective action from the claimant 16

Representatives Responsibilities Field Representatives and County Veteran Service Officers (CVSOs): At the discretion of the Department Service Officer, VFW accredited representatives, particularly those not stationed at VA regional offices, have the authority to submit correspondence, applications, evidence, etc., pertaining to individual claims for benefits administered by the Department of Veterans Affairs directly to the Department of Veterans Affairs. In other words: the DSO has the authority to require field offices & CVSOs to submit claims paperwork to the DSO s office prior to submittal to VA. HOWEVER 17

Representatives Responsibilities Field Representatives and County Veteran Service Officers (CVSOs): In the event that a claim is submitted timely to the DSO but is not subsequently submitted timely to the VA, it shall be incumbent on the DSO s employer to make reparation through appropriate channels for any monetary damages that occurred as a result of the untimely submission. In the event that an accredited representative does not submit a claim to VA in a timely manner, it shall be incumbent on the accredited representative s employer to make reparation through appropriate channels for any monetary damages that occurred as a result of the untimely submission. NVS Policy & Procedures: Representation Administrative(1)(a & b) 18

NVS Procedures for Misfiled Claims Upon NVS being notified by a DSO or Department Adjutant that there has been an untimely submission: NVS will document the occurrence should the untimely submission turn into a misfiled claim for which the claimant seeks damages. *Reminder: An untimely submission does not necessarily constitute a misfiled claim. 19

NVS Procedures for Misfiled Claims Upon NVS being notified by a DSO or Department Adjutant that there has been a misfiled claim NVS will: Document the occurrence should the claimant seek damages from VFW due to the misfiled claim Review pertinent documents / statements made available to us from the DSO 20

NVS Procedures for Misfiled Claims Upon NVS being contacted by a claimant seeking damages for a misfiled claim, NVS will: Document the communication Notify the DSO and/or Department Adjutant of the communication Send claimant a response letter soliciting relevant evidence pertinent to the misfiled claim Send claimant a consent to release information form 21

NVS Procedures for Misfiled Claims Upon NVS receiving the signed release of information form from the claimant, NVS will: Review all evidence associated with the alleged occurrence Compile a factual report of the occurrence. The report will include: Date and circumstances of alleged submission from claimant to VFW representative Date of submission from VFW representative to VA Previous VA Rating Decision Rating Decision which resulted from the misfiled claim Calculation of monetary loss from alleged misfiled claim NVS will send report with pertinent evidence to VFW General Counsel 22

NVS Procedures for Misfiled Claims Upon VFW General Counsel receiving report from NVS, General Counsel will: Contact Department Leadership & claimant to review the report Make a determination if VFW will pay damages If applicable, serve as a mediator between the Claimant, Department, & Insurance Company in order to agree on the appropriate course of action 23

Questions? 24