the adjutant general directorate “people always... mission first” [presenter] crsc/tsgli...

The Adjutant General The Adjutant General DirectorateDirectorate

“People Always ... Mission First”

[PRESENTER]CRSC/TSGLI Division

(Date)

[EVENT NAME]TSGLI and Introduction to CIP and CRSC

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The Adjutant General DirectorateThe Adjutant General Directorate“People Always ... Mission First”

• TSGLI is a Department of Veterans Affairs insurance program created by congress and bundled with Servicemembers Group Life Insurance coverage

• As of 31 May 2007 the Army’s TSGLI program has approved more than 2,000 claims

• The TSGLI program has given out almost $126 million of the total $203 million paid out across all branches of service

• TSGLI helps injured Soldiers and their Families– Designed to help with expenses and get a head start on life after recovery– Provides a one-time payment for eligible Soldiers and their Families– Offers free financial counseling from FinancialPoint to recipients

Traumatic Servicemembers’ Group Life Insurance (TSGLI)

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Qualifying Traumatic Injuries or Losses

Qualifying injuries (losses) As a result of (event examples)

Amputation

Loss of Sight, Speech or Hearing

Paralysis

Brain Injury or Coma

Burns

Other traumatic injuries resulting in loss of Activities of Daily Living (ADL’s)

ImprovisedExplosive Device

Rocket PropelledGrenade

Training Accident

MotorcycleAccident

Civilian AircraftAccident

Vehicle Borne Improvised

Explosive Device

Small Arms

Civilian Car Accident

Definition of Qualifying Event: Injury or loss caused by external force or violence (a traumatic event)

Losses #1-43

Loss #44

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Activities of Daily Living (ADLs) Loss Descriptions

Eating

Bathing

Dressing

Toileting

Transferring

Continence

…on another person or a feeding tube to receive nourishment

…on another person (can’t bathe independently)

…on another person to help put on shoes and socks (for example)

…or unable to relieve bladder/bowelor perform associated hygiene

…on another person to get in and out of bed or chair

…or unable to manage and control bowel and bladder function

Completely Dependent…

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“TNT” —Time and Type of ADL Loss

There must be no break in the period of ADL loss—otherwise the clock re-starts. Currently, the ADL standards are being reevaluated.

120

90

60

30

Other Traumatic Injuries (OTI): The Soldier must have ADL loss in increments of…

$100,000

$75,000

$50,000

$25,000

To receive a one-time TSGLI payment of…

90

60

30

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Traumatic Brain Injury (TBI): The Soldier must have ADL loss in increments of …

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Time Constraints

• You may apply for TSGLI at any time after a qualifying loss occurs

• Qualifying loss must have happened within 730 days of the traumatic event to be eligible for TSGLI

• Traumatic events that happen less than seven days apart are considered one traumatic event

• Traumatic events more than seven days apart are considered more than one traumatic event

• A deceased Soldier must have survived at least seven days after a traumatic event to be eligible for TSGLI—otherwise only SGLI (life insurance) coverage applies

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TSGLI Eligibility—Circumstances

RETROACTIVERelated to combat zones

PROSPECTIVEAny time, anywhere

7 October 2001 – 30 November 2005 1 December 2005 – forward

Qualifying traumatic injury must occur while on orders in a Combat Zone Tax Exclusion (CZTE) area

Soldier does not have to be currently serving in Army

SGLI coverage not necessary

Qualifying traumatic injury can occur under any circumstances—doesn’t have to be combat-related

Traumatic injury does NOT have to occur while on orders

Soldier must have SGLI coverage

Two Programs:

Pending legislation: Senate Bill 225 would do away with the retroactive CZTE requirement, offering “anytime, anywhere” coverage for all Soldiers with qualifying injuries from 7 October 2001 to now.

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Claim Form Part A - Servicemember

PART A – Member’s Identifying Information

Section 1 – Servicemember Information

Section 2 – Guardian and Attorney-in-fact Information

Section 3 – Payment Information

Section 4 – Signature

Section 5 – Authorization to Speak to Third Party

Section 6 – Authorization to Release Information

Filled out by Servicemember or advocate

Filled out by Servicemember or advocate

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Claim Form Part B – Licensed Medical Provider

PART B – Licensed Medical Provider’s Statement

Section 1 – Patient and Injury Information

Sections 2 – 10 Losses Suffered by Patient

Section 11 – Medical Professional’s Comments

Section 12 – Contact Information

Section 13 – Medical Professional’s Signature

Two-page ADL Questionnaire

MUST be completed by a licensed Medical Provider— does not necessarily have to be

a physician

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Supporting Documentation

Submit only documents pertinent to loss(es):

• Provides duration of ADL loss and type of injury

• Provides basis for certification of loss

• Balances out healthcare-provider subjectivity

• Provides a scale/standard for reviewer

• Allows for quicker claim processing (If all of the proper medical documentation is submitted with a TSGLI claim, typical resolution takes about 30 days from date of receipt)

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• Qualified licensed healthcare providers give primary certifying statements:– Physicians– Physician Assistants– Nurse Practitioners– Registered Nurses

• Other healthcare providers give supporting documentation statements within their lane of expertise:– Registered Dieticians– Optometrists– Audiologists– Speech/Language Pathologists– Occupational/Physical Therapists– Dentists– Other licensed medical providers within his/her scope of practice

Licensed Medical Providers

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Documents commonly used to support TSGLI claims

• Occupational/Physical Therapy Report (ADL Documentation)• Neurological Reports (TBI/ADL Documentation)• Nurses Notes (ADL Documentation)• OR Report (amputation)• Hearing Test Results (for hearing loss)• Eye Test Results (for sight loss)• Speech Test Results (for speech loss)• Patient Discharge Summaries • Medical Summary and/or History • Patient Movement Request• Radiographic Reports (X-Ray, MRI, Ultrasound, etc.)• Accident Report• Line of Duty (LOD)• Medical/Physical Evaluation Board (MEB/PEB)• Other diagnostic test results (e.g., lab reports, etc.)• Other pertinent documents demonstrating time duration of ADL loss and

type of injury

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Claim Form Part C – Human Resources Command

Office of Servicemember’s Group Life Insurance (OSGLI)

receives Certified Claim.

Branch of Service Validates Info in Parts A&B and

Completing Part C to Certify Claim

Do NOT complete this form—TSGLI will complete it

Branch of Service Validates Info in Parts A&B and

Completing Part C to Certify Claim

Do NOT complete this form—TSGLI will complete it

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Servicemember Sends Claim Form

• E-Fax 1-866-275-0684• [email protected]• Address:

200 Stovall StreetAlexandria, VA 22332-0470

ONLY send claims through the secure channels below:

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Multiple Claims Reconsiderations and Appeals• Multiple Claim Submissions are possible for:

– Consecutive periods of ADL loss– Additional traumatic event(s)– Multiple injuries DO NOT require multiple claim forms

• Reconsideration– If a Servicemember feels that his/her claim has been wrongly denied,

there are three levels of appeal. Each of them will require gathering additional information and documentation to prove the case. The process is as follows:

First: Reconsideration - The Servicemember may gather additional supporting documentation and apply for a reconsideration

Second: Army Appeals Board - If the claim is still denied, the Servicemember can supply additional medical documents and appeal the claim to the U.S. Army TSGLI Appeals Board

Third: ARBA Appeals Board - The third level of the appeal process is to apply to the U.S. Army Review Board Agency (ARBA).

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Where we are today— and how you can help

• The program is maturing and there are still significant improvements that need to be made through the VA

• The Army can only run the program by the rules created by Congress and the VA—the Army can not change program guidance

• We CAN AND DO influence Congress and the VA to make changes that will improve TSGLI and better serve the Soldier

• Your feedback helps us influence Congress—we have already made improvements to claim forms and processes based on feedback from people who care for Soldiers

• We have given our feedback on program issues to the VA and expect certain improvements to be made to the program by Fall of 2007. Thank you for your help in telling us your experience

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TSGLI—Takeaways

1. Traumatic Injury definition:– Caused by external force or violence

2. Medical documentation must substantiate duration of each ADL impacted

3. Every case is different– Each case stands on its own; every injury is different– Circumstances, injury specifics and documentation vary

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Combat-Related Injury Rehabilitation Pay (CIP)

Combat-Related Special Compensation (CRSC)

Benefit Programs Related to TSGLI

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Combat-Related Injury Rehabilitation Pay (CIP)

• Congressionally mandated Special pay program effective 23 March 06• No claim process – awarded automatically• Criteria for Eligibility

Must have been MEDEVACED from Combat Zone Inpatient in a medical treatment facility (MTF) Outpatient of an MTF Payment continues as long as a Soldier remains under MTF control

• CIP Termination TSGLI payment or notification of payment Released to Unit or Demobilization Site REFRAD Assigned to Community Based Healthcare Organization* Convalescent Leave* Transferred to VA Poly Trauma* No Restarts once terminated, unless return to Theater Reconsiderations and appeals are possible

* NOTE: under policy revision

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CIP – A Decision

CIP Compensation BreakdownHardship Duty Pay – Location (HDP-L) $100Hostile Fire /Imminent Danger Pay (HF/IDP) $225Per Diem for meals & incidentals $3.50 x 30 $105Total CIP monthly payment: $430

Mos CIP Benefit

12 $5,160

24 $10,320

36 $15,480

Because TSGLI and CIP are mutually exclusive programs, each Soldier must decide with their Family to determine if and when TSGLI and CIP are right for their particular situation. Below is an outline of CIP pay and how it stacks up over time.

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Combat-Related Special Compenstion (CRSC)

• What is CRSC? CRSC restores military retired pay to eligible retired veterans CRSC is a monetary award paid monthly Retired veterans must have a 10-100% disability rating, draw military

retired pay and VA disability payments

• How does CRSC help retired veterans? CRSC replaces VA disability compensation subtracted from retired pay CRSC recognizes veterans for their sacrifice to our country

• How do we execute CRSC? Shape perceptions of Soldiers, healthcare providers, counselors, and

advocates (SRTV, events, VSO’s, direct mail, electronic media) Adjudicate claims: new, reconsiderations, and appeals Validate approval payments to DFAS Digitize case files to iPERMS Serve veterans through Call Center, IVR, and dynamic website

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Who is Eligible for CRSC?

Must Have

ALL Four At Least One AND

1. AC, RC, NG or medically retired with 20 years

2. 10% or greater VA rated injury

3. Receiving military retired pay

4. Military retired pay is reduced by VA disability payments (VA Waiver)

1. Simulating War (SW)

2. Hazardous Service (HS)

3. Instrumentality of War (IN)

4. Armed Conflict (AC)

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CRSC: www.crsc.army.mil Website: TSGLI: www.tsgli.army.mil

CIP: www.dfas.mil

Email: CRSC: [email protected] TSGLI: [email protected]

CRSC: 1-866-281-3254 Call: TSGLI: 1-800-237-1336

CIP: 1-888-332-7411(M-F 0800-1900 hrs EST)

QuestionsBecome an Official Ambassador - Contact us above!

We recognize that all injuries impact a Soldier’s life, and we appreciate the sacrifice of every Soldier.

the adjutant general directorate “people always... mission first” [presenter] crsc/tsgli...

Documents

duration of adl loss

traumatic eventlosses

tsgli claim

eligible soldiers

proper medical documentation

armys tsgli program

claimsthe tsgli program

qualifying injuries