VA Form 10-1023: Download PDF & Instructions – Veterans receiving VA medical care for injuries or conditions potentially caused by a third party (such as in accidents, tort claims, or workers’ compensation cases) may need to complete VA Form 10-1023. This form helps the VA identify opportunities to recover costs of care under federal third-party liability rules, protecting taxpayer funds while supporting veterans.
What Is VA Form 10-1023?
VA Form 10-1023, titled “Information Regarding Possible Claim Against Third Party”, is a one-page medical form (revised June 2007) used by the Department of Veterans Affairs. Veterans (or someone furnishing information on their behalf) provide details about an injury, disease, or incident that led to VA treatment, along with any potential claims against third parties like tortfeasors, insurers, or workers’ compensation.
It supports the VA’s Federal Medical Care Recovery Program efforts to bill liable third parties for nonservice-connected care costs.
Purpose of VA Form 10-1023
The primary purpose is to notify the VA of potential third-party liability. This allows the VA to:
- Assess and pursue recovery of medical costs from responsible parties (e.g., at-fault drivers, employers, or insurers).
- Coordinate with veterans’ personal injury claims or workers’ compensation.
- Ensure veterans do not bear unnecessary copayments when third parties are liable.
Filling it out fulfills part of the veteran’s duty to report such incidents when seeking VA care for related conditions. Failure to provide information can delay billing or recovery processes.
When to Use VA Form 10-1023?
Use this form if you received VA treatment for an injury or illness possibly caused by:
- A tort (e.g., car accident, slip-and-fall).
- Workers’ compensation.
- Crimes of personal violence.
- “No fault” insurance.
- Other third-party liability scenarios.
It is often requested by VA facilities or the Office of General Counsel when processing care related to personal injury or workers’ comp. Veterans or their representatives (like attorneys) should submit it promptly.
How to Fill Out VA Form 10-1023?
The form is straightforward and fillable. Key sections include:
- Veteran’s Information: Name, SSN, address, telephone, date of report.
- Injury/Disease Details: Nature of injury or disease, date/time/location/description of incident.
- Third-Party Information: Name/address of third party (tortfeasor, etc.), type of claim (tort, workers’ comp, etc.), insurance details.
- Claim Status: Whether a claim was submitted (orally or in writing), to whom, and when.
- Witnesses and Investigation: Names/addresses of witnesses; authorities involved.
- Attorney Information: If you’ve contacted an attorney.
- Remarks: Any additional details.
Print or type clearly. Submit to the specified VA facility or District Counsel. Always keep copies for your records.
Pro Tip: Consult a VA-accredited representative, attorney, or VSO if involved in a legal claim to ensure coordination.
Where to Download VA Form 10-1023?
You can download the official fillable PDF directly from the VA:
Download VA Form 10-1023 (PDF)
For the latest version and instructions, visit the official VA forms page:
VA Form 10-1023 Overview
Submitting VA Form 10-1023 and Related Processes
Submit the completed form to your VA medical facility or the address indicated (often District Counsel). For billing requests related to personal injury or workers’ compensation, use the VA’s dedicated process and forms from the Office of General Counsel.
If you’re working with an attorney on a third-party claim, they can assist with coordination. Veterans may also request VA medical bills to support their own claims.
Important Considerations for Veterans
- Timeliness: Report promptly to avoid delays in care or recovery.
- Coordination: This form supports—not replaces—your private legal claims. VA subrogation rights may apply.
- Privacy: Information is protected under VA privacy rules and used for recovery purposes.
- Help Available: Contact your local VA facility, call VA at 1-800-827-1000, or work with accredited representatives. For complex cases, consult a veterans’ law attorney.
Understanding and using VA Form 10-1023 correctly helps ensure VA can recover costs efficiently, benefiting the entire veterans’ community. Always rely on official VA sources for the most current guidance.
This article is for informational purposes only and is not legal advice. Consult official VA resources or a qualified professional for your specific situation.