January 5, 2008 – Too many severely injured troops and their families haven’t been getting the bedside help they need in preparing applications to qualify for up to $100,000 in traumatic injury insurance. But that is going to change, says Army Col. John Sackett.
Sackett heads the Traumatic Servicemembers’ Group Life Insurance (TSGLI) branch within the U.S. Army Human Resources Command in Alexandria, Va. More than 6,600 claims for TSGLI have been filed by wounded or injured soldiers since the program began Dec. 1, 2005.
But only 2,700 Army claims, about 40 percent of the total, have been approved.
Many more wounded members from all services would be found eligible for TSGLI if servicemembers, family caregivers and especially medical staff were better informed on the kind of detailed documentation TSGLI requires, Sackett said.
To increase their knowledge, and boost the number of claims approved, the Army is assigning Soldier Family Support Specialists to 10 military treatment facilities critical in the treatment of trauma patients.
These specialists already are deployed and holding TSGLI training sessions at a number of military medical facilities, and more of these counselors are being trained to deploy soon.
Every member covered by Servicemembers’ Group Life Insurance also pays an extra $1 a month for traumatic injury protection. TSGLI pays $25,000 increments, up to $100,000, to help severely injured members and families handle the extra expense and the strain of adjusting to life-altering injuries.
The Department of Veterans Affairs, which administers TSGLI, lists 44 types of losses that can qualify a member for payment. Conditions not difficult to document involve the loss of body parts or bodily functions, severe burns, or severe brain and spinal chord injuries.
A far bigger and more complex problem in preparing TSGLI claims, however, involves members who suffer severe wounds to limbs that are saved or have mild traumatic brain injury. The trauma can leave them dependent on others to perform “activities of daily living” for extended periods.
If unable to independently perform two or more of these activities for 30 days, the member will qualify for $25,000 in TSGLI. If debilitated in this way for 120 days would qualify for the maximum award of $100,000.
Of nearly 3,700 Army TSGLI claims rejected by the VA, about 90 percent involve claims of members’ lost ability to perform activities of daily living. Sackett said they are being rejected because caregivers aren’t documenting what VA needs to see to prove loss of ability to perform activities.
“The way to resolve this is to put boots on the ground, so to speak, to help the individuals get the necessary documentation they need at the military treatment facility,” Sackett said.
In recent months the VA has relaxed the degree of debilitation that needs to be documented. It used to require evidence that members were “completely dependent” on others for two or more activities of daily living for 30 to 120 days. Now caregivers need only show that members were unable to “independently perform” these activities for the required periods of time.
From this change alone, said Christian Harris, program managers for the Army TSGLI outreach program, claim approval rates are starting to rise.
“We [also] are working with VA to try to adjust program guidance to include a wider array of debilitating injuries,” Harris said.
Wounded servicemembers and their families also need to understand how early application for TSGLI can cut off their eligibility for Combat Injury Pay and thus lower a member’s total compensation over time, Sackett said.
A year ago Congress decided it was unfair that servicemembers wounded in a war saw hostile fire pay, imminent danger pay and hazardous duty pay end within a month of being evacuated.
So since March 23, 2006, medical evacuees have been able to draw Combat Injury Pay which replaces war zone pays that stop during hospitalization or rehabilitation. CIP can total $430 a month.
But wounded servicemembers should be aware that CIP ends when a member is awarded TSGLI. Those facing long periods of convalescence could be denying themselves almost $5,200 a year if they apply too early for TSGLI, Sackett said. TSGLI specialists will include this in their briefings.