Traumatic Injury Servicemembers Group Life Insurance (TSGLI) Coverage

Transcription

1 30-05 December 28, 2005 Traumatic Injury Servicemembers Group Life Insurance (TSGLI) Coverage PL , enacted in May 2005, provided for one sum TSGLI payments ranging from $25,000 to for those Servicemembers Group Life Insurance (SGLI) insureds incurring certain physical traumatic injuries on or after the effective date of December 1, A provision of the legislation provided a retroactive period back to October 7, 2001 for SGLI insureds whose injury was a direct result of being incurred in Operations Enduring Freedom and/or Iraqi Freedom. For the purposes of TSGLI only, incurred in Operation Enduring Freedom or Operation Iraqi Freedom means that the member must have been deployed outside the United States on orders in support of OEF or OIF or serving in a geographic location that qualified the service member for the Combat Zone Tax Exclusion under the Internal Revenue Service Code. Payments under this provision are based on the severity of the physical trauma incurred, and must involve a scheduled loss such as loss of limbs, sensory organ loss, physical brain trauma resulting in loss of brain function(s), certain types of paralysis, etc. Mental illnesses will not be covered by this insurance. A schedule of covered injuries/losses and the related insurance payments is included below. All service members who have SGLI will also have TSGLI coverage effective December 1, This is automatic for those insured under basic SGLI and cannot be declined except by a service member declining basic SGLI itself. This coverage does not include dependent coverage and is not available to Veterans Group Life Insurance (VGLI) policyholders. Covered losses must be a scheduled loss and must be a direct result of a traumatic injury suffered prior to midnight of the day the member separates from his or her uniformed service. The scheduled loss must be suffered within 365 days of the traumatic injury. This insurance benefit requires that a claim be filed through the member s service department, with the signature of the member, or be signed by his or her power of attorney/guardian/custodian. The TSGLI Certification Form (GL ) is a multi-page form than can be downloaded at or which can be obtained from the member s service department point of contact, or from the SGLI center by phoning Multiple claims may be needed in certain circumstances. For losses such as coma or traumatic brain injury, the TSGLI benefit is payable in $25,000 increments on the 15th, 30th, 60th, and 90th consecutive

2 days of the member s inability to carry out activities of daily living. A separate claim for TSGLI must be filed at each time interval. For example, if a service member suffers a traumatic injury that leaves him in a coma, a claim for TSGLI should be filed after the 15th consecutive day of the member being in a coma for which $25,000 is payable. If the member remains in a coma for 30 days after the traumatic injury, another claim should be submitted and another $25,000 will be paid. If a member files a claim for an incurred loss and then subsequently incurs another loss as a result of the same traumatic event, a new claim must be filed for the subsequent loss. For example, if a member files a claim for losing one leg as a result of an explosion and four months later has the other leg amputated as a result of that same explosion, the member must file another claim for the loss of the leg. TSGLI does not affect any other VA benefits for these members and its proceeds may be used for any purpose the recipient wishes.. Only the injured service member is the beneficiary, save where the member dies as a result of the traumatic injury and survived for a period of not less than seven (7) full days from the date of the traumatic event and died before the maximum benefit for which the service member qualifies is paid; the seven day period beginning on the date and time of the traumatic event as measured by Greenwich Meridian/Zulu time and ending 168 full hours later. In such cases the beneficiary of the TSGLI payment will be the beneficiary(s) of the member s basic SGLI. The premium for TSGLI is a flat rate of $1 per month for active duty members and Reservists with full time SGLI coverage. It is $1.00 per year for Reservists with part time SGLI coverage, and no charge for funeral honors and 1 day muster duty. For example, members who carry the maximum SGLI coverage of $400,000 a month at a cost of $26 per month began paying $27 a month beginning December 1, Note: These rates are determined by VA and are subject to change based on claims experience. As of December 21, 2005 the Internal Revenue Service has not ruled yet on whether TSGLI payments are taxable for federal income tax purposes, though such has been requested by the DVA. State and/or Local tax effects also have yet to be determined by their respective jurisdictions. Recipients should therfore make inquiry on this to the IRS and their appropriate state and local government revenue offices. More detailed information on the TSGLI benefit can be obtained by referring to title 38, CFR, Part 9.20 at by contacting the member s service department point of contact or the Office of Servicemembers Group Life Insurance by phone at , or by at osgli.claims@prudential.com, and at Payments again are in $25,000 increments from $25,000 to. The Department of Defense will certify to the Office of Servicemembers Group Life Insurance (OSGLI) those to be paid and the amount. The Dept. of Veterans Affairs will not be directly involved where individual cases are concerned, but will exercise general oversight. The retroactive part of the payment process should be automatic in most cases. However, those who feel they meet the criteria for retroactive payments, but who think they may not be contacted for some reason, and who wish to check this with their military service department, can do so as follows, along with those who are filing or seeking information on current claims: TSGLI Points of Contact List by Branch of Service Branch of Service Army General Information Phone: (800) tsgli@hoffman.army.mil 2 Claims Information (866)

3 Navy Air Force Phone: (800) Phone: (210) (901) (210) USMC Coast Guard Public Health Service NOAA Phone: (703) Phone: (202) Phone: (301) Phone: (301) (888) (202) (301) or (800) (301) TSGLI Schedule of Payments for Traumatic Losses If the loss is-- Then the amount that will be paid is-- 1 Total and permanent loss of sight in both eyes. 2 Total and permanent loss of hearing in both ears. 3 Loss of both hands at or above wrist. 4 Loss of both feet at or above ankle. 5 Quadriplegia. 6 Hemiplegia. 7 Paraplegia. 8 3rd degree or worse burns, covering 30% of the body or 30% of the face. 9 Loss of one hand at or above wrist and one foot at or above ankle. 3

4 10 Loss of one hand at or above wrist and total and permanent loss of sight in one eye. 11 Loss of one foot at or above ankle and total and permanent loss of sight in one eye. 12 Total and permanent loss of speech and total and permanent loss of hearing in one ear 13 Loss of one hand at or above wrist and total and permanent loss of speech. 14 Loss of one hand at or above wrist and total and permanent loss of hearing in one ear. 15 Loss of one hand at or above wrist and loss of thumb and index finger of other hand. 16 Loss of one foot at or above ankle and total and permanent loss of speech. 17 Loss of one foot at or above ankle and total and permanent loss of hearing in one ear. 18 Loss of one foot at or above ankle and loss of thumb and index finger of same hand. 19 Total and permanent loss of sight in one eye and total and permanent loss of speech. 20 Total and permanent loss of sight in one eye and total and permanent loss of hearing in one ear. 21 Total and permanent loss of sight in one eye and loss of thumb and index finger of same hand. 22 Total and permanent loss of thumb of both hands, regardless of the loss of any other digits. 23 Total and permanent loss of speech and loss of thumb and index finger of same hand. 24 Total and permanent loss of hearing in one ear and loss of thumb and index finger of same hand Loss of one hand at or above wrist and coma. $50,000 for loss of hand 26 Loss of one foot at or above ankle and coma. $50,000 for loss of foot 27 Total and permanent loss of speech and coma. $50,000 for total and permanent loss of speech plus the amount paid for coma as noted in Item 37 of this schedule up to a combined maximum of. 28 Total and permanent loss of sight in one eye and coma. $50,000 for total and permanent loss of sight in one eye plus the amount paid for coma as noted in Item 37 of this schedule up to a combined maximum of. 29 Total and permanent loss of hearing in one ear and coma. $25,000 for total and permanent loss of hearing in one ear plus the amount paid for coma as noted in Item 37 of this schedule up to a combined maximum of. 30 Loss of thumb and index finger of same hand and coma. $50,000 for loss of thumb and index finger of the same hand plus the amount paid for coma as noted in Item 37 of this schedule up to a combined maximum of. 31 Total and permanent loss of sight in one eye and inability $50,000 for loss of sight in one eye plus the amount

5 to carry out activities of daily living due to traumatic brain injury. 32 Loss of one hand at or above wrist and inability to carry 33 Loss of one foot at or above ankle and inability to carry 34 Loss of thumb and index finger of same hand and inability to carry out activities of daily living due to traumatic brain injury. 35 Total and permanent loss of hearing in one ear and inability to carry out activities of daily living due to traumatic brain injury. 36 Total and permanent loss of speech and inability to carry 37 Coma from traumatic injury and/or the inability to carry Note 1: Benefits will not be paid under this schedule for concurrent conditions of coma and traumatic brain injury. Note 2: Duration of coma includes the day of onset of the coma and the day when the member recovers from coma. Note 3: Duration of the inability to carry out activities of daily living due to traumatic brain injury includes the day of the onset of the inability to carry out activities of daily living and the day the member once again can carry out activities of daily living. paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. $50,000 for loss of hand plus the amount paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. $50,000 for loss of foot plus the amount paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. $50,000 for loss of thumb and index finger plus the amount paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. $25,000 for total and permanent loss of hearing in one ear plus the amount paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. $50,000 for total and permanent loss of speech plus the amount paid for the inability to carry out activities of daily living due to traumatic brain injury as noted in Item 37 of this schedule up to a combined maximum of. At 15th consecutive day in a coma, and/or the $25,000 At 30th consecutive day in a coma, and/or the Additional $25,000 At 60th consecutive day in a coma, and/or the Additional $25,000 At 90th consecutive day in a coma, and/or the Additional $25, Total and permanent loss of speech. $50, Loss of one hand at or above wrist. $50, Loss of one foot at or above ankle. $50, Total and permanent loss of sight in one eye. $50, Loss of thumb and index finger of same hand. $50, Total and permanent loss of hearing in one ear. $25,000 (Benefits can be paid for both conditions only if experienced consecutively, not concurrently.) 5

6 44 The inability to carry out activities of daily living due to loss directly resulting from a traumatic injury other than an injury to the brain. At 30th consecutive day of the inability to carry out activities of daily living $25,000 Note: Duration of the inability to carry out activities of daily living includes the day of onset of the inability to carry out activities of daily living and the day when the member can once again carry out activities of daily living. At 60th consecutive day of the inability to carry out of activities of daily living Additional $25,000 At 90th consecutive day of the inability to carry out activities of daily living Additional $25,000 At 120th consecutive day of the inability to carry out activities of daily living Additional $25,000 ********************************************************** PETER S. GAYTAN, Director National Veterans Affairs and Rehabilitation Commission 6