VA expands TSGLI payment eligibility
May 31, 2011
By J.D. Leipold
WASHINGTON (Army News Service, June 1, 2011) -- Soldiers previously ineligible to receive insurance payments for injuries they received outside of Operations Iraqi Freedom and Enduring Freedom will soon have the opportunity to submit claims for Servicemembers' Group Life Insurance Traumatic Injury Protection Program.
Effective Oct.1, 2011, servicemembers outside a combat zone who suffered a qualifying injury -- such as loss of a limb or an eye for example -- may be entitled to $25,000 up to a $100,000 maximum total for all qualifying injuries received between Oct. 7, 2001, and Nov. 30, 2005, regardless of where the injury occurred.
Previously, only servicemembers who had been injured while serving in Iraq or Afghanistan between those dates were entitled to the TSGLI injury benefit, which was added to the SGLI death benefit policy on Dec. 1, 2005, but made retroactive to Oct. 7, 2001. Servicemembers did not need to have SGLI coverage during this retroactive period in order to be eligible for TSGLI. Servicemembers who had SGLI as of Dec. 1, 2005, were automatically enrolled in TSGLI.
"The Veterans Administration is charged by law with managing the insurance program," said Stephen Wurtz, VA deputy assistant director for insurance. "In 1965 the VA bought a group policy from a commercial insurance company and that company does the day-to-day functions of the programs, whether it's paying claims or collecting premiums."
Wurtz added that the VA and service branches are notifying individuals who had been turned down due to the previous requirement that the injury must have taken place in theater. He noted that current servicemembers and veterans who suffered qualifying injuries between Oct. 7, 2001, and Nov. 30, 2005, should be proactive in filing claims beginning Oct. 1, 2011.
"We'll work hard to get the word out and to locate as many individuals as possible and to work with the branches of service in collecting the information they'll need, such as the medical evidence to document their claims," Wurtz said, adding that the TSGLI benefit in no way affects VA benefits.
If the individual service determines the injury meets the criteria, it then determines the amount of payment. The service next sends the decision to the insurance company, which will generate payment.
If the service determines the injury doesn't meet the criteria, the service will notify the insurance company, which will in turn send a letter to the claimant informing them they are not eligible to receive payment and the reason for that decision.
Congress and the president mandated the change to TSGLI through passage of the Veterans' Benefits Act of 2010. TSGLI coverage includes all servicemembers, active-duty, as well as inactive Reserve and Guard, regardless of where they were at the time their injury occurred. While SGLI may be carried by veterans for 120 days after discharge (or two years if totally disabled), the TSGLI policy does not transfer once a servicemember has left active service.
More than $550 million in TSGLI benefits has been paid since the program was initiated in 2005. TSGLI covers a wide range of injuries and losses, including amputations, limb salvage, paralysis, burns, loss of sight, hearing or speech, facial reconstruction and also provides benefits for a servicemember's inability to perform daily living activities due to traumatic brain injury or other traumatic injuries.
For more information on TSGLI and a complete list of qualifying losses, visit the VA website at: http://www.insurance.va.gov/sgliSite/TSGLI/TSGLI.htm