RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

TRAUMATIC INJURY INSURANCE 1 August 2008

Posted by Service Officer on July 31st, 2008

Traumatic injury insurance is part of the Servicemembers’ Group Life Insurance program. A monthly premium of $1 is charged on top of the normal SGLI premium for coverage aimed at helping troops and their families with the financial difficulties of severe injuries. More than 1,600 severely disabled veterans could receive retroactive traumatic injury insurance payments as a result of a newly released review of how benefits have been paid under the 3½-year-old supplemental benefits program. The payments, which range from $25,000 to $100,000, could be paid as early as this fall as a result of discussions between the Department of Veterans Affairs, which runs the program, and doctors who are treating severely wounded combat veterans. The average retroactive payment would be $32,000, according to the JUL dated review. About 4,400 people have received traumatic injury insurance payments since the program was created in 2005. The estimated 1,640 people who would receive retroactive benefits as a result of the review include some who did not previously qualify and some who received payments but now would get more, according to VA officials. Officials said the report offers 11 recommendations to expand definitions of traumatic injury for insurance purposes, and all are expected to be included in a revised regulation likely to be issued by VA this fall. No payments can be made until final regulations are issued, but the new definitions would apply to new injuries and also retroactively to injuries since 7 OCT 01.

 

Officials said that although the recommendations are not controversial and appear to have widespread support, the regulations that will spell out the changes are not final. More than three-quarters of the people due payments as a result of the review suffered a traumatic brain injury or another traumatic injury that resulted in their being hospitalized for 15 consecutive days or more since 11 SEP 01, but did not qualify for insurance payments under the existing criterion. Those criterion use a six-part test to determine who can receive financial help by measuring a person’s ability to carry out daily activities: eating, bathing and using a toilet. That criterion would still be used, but inpatient hospitalization for 15 continuous days would be a new way to qualify. The average insurance payment would be $25,000 for those retroactively covered by the change, the report said. Traumatic brain injuries and similar trauma have accounted for 2,550 of the 4,400 payouts of traumatic injury insurance. Another proposed change would extend coverage to about 300 people who suffered limb injuries so severe that amputation was possible but who, instead, have undergone multiple surgeries to save the limb. VA officials said doctors at Walter Reed Army Medical Center in Washington and at Brooke Army Medical Center in San Antonio said limb salvage requires more rehabilitation than amputations.

The services, especially medical staff, are heavily involved in the process because, for a service member to receive the benefit, a medical professional must document the injury. One recommended change would provide an insurance payment if a service member loses sight in both eyes for 120 days, a change from the current standard that requires total and permanent loss of sight. The program provides $100,000 for loss of sight in both eyes and $50,000 for the loss of sight in one eye. The definition of amputation of a hand or foot would change to include the loss of four fingers on a hand or four toes or more on a foot, or the loss of a thumb or big toe. The benefit would be $50,000 for one affected hand and $100,000 if both are affected, and $25,000 for one affected foot and $50,000 if both are affected. The standard for determining when someone is severely burned also would change. The current standard provides payment for a third-degree burn covering at least 30 percent of the face or body. The review recommends payment for second-degree burns covering 20% of the face or body after military doctors said that second-degree burns require the same rehabilitation as third-degree burns. The benefit for severe burns is $100,000. Facial reconstruction, not currently covered, would be added, with payments ranging from $25,000 to $75,000, depending on the severity of the injury and the surgery required. Complete and total paralysis of a limb also would be added as a traumatic injury, worth a payment of $50,000. [Source: ArmyTimes Rick Maze article 28 Jul 08 ++]

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