TSGLI Program Changes - Life Insurance

TSGLI Program Changes - Life Insurance
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Veterans Benefits Administration
Life Insurance

TSGLI Program Changes
Life Insurance
TSGLI Program Changes
Why Are We Making Changes to the TSGLI Program?
VA conducted a review of TSGLI as part of its ongoing oversight of the program. The objectives of the review were to:
assess proposals for program improvements,
clarify complex eligibility standards to promote consistency in adjudication and improve the claims experience for Servicemembers,
identify administrative or operational enhancements, and
determine if the program is meeting its congressional intent.
Based on this review, VA has made a range of changes to the TSGLI Program to improve the program.
How has the Schedule of Losses Changed?
Based on the review, VA made changes to the following areas of the Schedule of Losses, effective date of regulation publication.
Loss Change
Explanation
Loss of Activities of Daily Living (ADL)
Defined each of the ADL to clarify what qualifies as loss of that ADL
Defined adaptive behavior and accommodating equipment to clarify that they impact determinations on when a member can perform an ADL
Defined the types of assistance needed (physical, stand-by, and verbal) that qualify as being unable to perform an ADL
Facial Reconstruction
Defined the terms “avulsion” and “discontinuity defect”, both key criteria to qualify for payment
Clarified where tissue and/or bone must be lost to qualify for payment
Hospitalization
Clarified the types of inpatient treatment settings that qualify as inpatient hospitalization
Clarified when hospitalization for assessments involving TBI/PTSD are payable
Clarified how hospital passes impact consecutive hospitalization days
Limb Salvage
Changed name of loss to Limb Reconstruction to better reflect the type of loss the program covers
Changed the eligibility criteria to provide a more objective standard
You can find more information on these changes on the
TSGLI Schedule of Losses
and in the
TSGLI Procedures Guide
How has the TSGLI Application Changed?
The TSGLI Application now clearly requires claimants to submit supporting evidence along with their claim form.  Part A of the TSGLI Application now includes a specific section (Section 6) requesting supporting evidence and asks the claimant to list the evidence being provided with the application.   The requirement for supporting evidence is in addition to a medical professional completing Part B of the application.
Supporting evidence is needed to document not only that the claimant meets the medical standard for the TSGLI loss they are claiming, but that they meet other eligibility criteria or program exclusions do not apply.
You can access the
TSGLI Application Form (SGLV 8600)
TSGLI Schedule of Losses on the VA Insurance Forms page.  For detailed information on completing the TSGLI Application, take our online training titled “
Completing the TSGLI Application (SGLV 8600) – A Guide for TSGLI Claimants and Medical Professionals
”.
What Other Changes Should I Be Aware Of?
The review also made changes to the following areas:
Change
Explanation
Defined External Force
Clarified the definition of traumatic event, one of the key criteria for TSGLI payment, by explaining what is and is not considered external force
Heat Stroke and Frostbite
Clarified that heat stroke and frost bite are traumatic events
Anaphylactic Shock from Bite/Sting
Clarified that a bite or a sting is a traumatic event and that losses due to anaphylactic shock from the bite or sting are not excluded by the illness/disease exclusion
Non-Penetrating Blast Waves
Clarified that non-penetrating blast waves are a traumatic event
Clarified that the two-year period for incurring a loss begins on the date the last verified non-penetrating blast wave occurred
Complications from Surgery Due to A Traumatic Event
Clarified that surgical complications alone do not qualify for TSGLI payment, but if the surgery was necessitated due to a traumatic event and complications caused a loss, TSGLI benefits can be paid.
Preexisting Conditions
Clarify that claimants will be entitled to payment for a TSGLI loss as long as any preexisting condition did not substantially contribute to that loss.
Clarify Standard of Evidence
Clarify application of 38 USC 5107(b) to the TSGLI program
Clarify TSGLI Appeal Process
Explain the three‐tiered uniform service appeals process
Explain that the existing one‐year limit on TSGLI appeals does not apply when the claimant submits new and material evidence
Explain that claimants must utilize the full three‐tiered uniformed service appeals process prior to litigating in federal district courts (38 USC 1975)
You can find more detailed information on each of these areas in the
TSGLI Procedures Guide
Is There Additional Training Available on Any of the Changes?
Yes, training is available.   VA has developed new online training modules on “Completing the TSGLI Application (SGLV 8600) – A Guide for TSGLI Claimants and Medical Professionals” and the “TSGLI Activities of Daily Living”.   Other online trainings that provide an overview of TSGLI, information on TSGLI coverage, and genitourinary losses were already available prior to the review.   All TSGLI Online trainings can be found on the
VA Insurance Training page
Where Can I Find Detailed Information on the TSGLI Program?
You can find comprehensive and detailed information on the TSGLI Program in the
TSGLI Procedures Guide
.  The Procedures Guide provide now includes all of the changes from VA’s review and is updated regularly should any additional changes occur.
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