Originally published July 18 2012
Federal government routinely denies medical claims to injured, disabled veterans
by J. D. Heyes
(NaturalNews) Eight U.S. Army veterans have claimed in court that the federal government denied their medical claims and that the government regularly does so with scores of other veterans as part of a "standardized" practice.
In the suit, the vets - led by plaintiff Dannie Fail - claim the Army's Servicemembers Group Life Insurance Traumatic Injury (TSGLI) program "has standardized the practices of denying claims [from injured veterans] in a manner that is arbitrary, unsupported by its own guidelines and contrary to law."
They went onto say that the program routinely denies benefits to vets injured overseas and elsewhere, which in turn forces them to utilize an appeals process to get their benefits - a process which often can be lengthy and taxing, financially and mentally.
In their suit, all eight plaintiffs said their injuries were legitimate - all were certified as such by a medical professional.
The complaint does not detail the veterans' injuries specifically, but it does list what sorts of injuries qualify them for the benefits.
Forced to appeal, with uncertain results
"There are nine categories of losses covered as follows: 1) Sensory losses, 2) Burns, 3) Paralysis, 4) Amputation, 5) Limb salvage, 6) Facial reconstruction, 7) Activities of daily living, 8) Inpatient hospitalization, 9) Coma/TBI (traumatic brain injury) combined with another injury," says the complaint.
When injured veterans seek coverage, say the plaintiffs, the U.S. government "adds a criterion negating ADL [Activities of Daily Living] coverage where there can be adaptive behavior to accomplish the activity, even though the adaptive standard is not contained in the manual or guideline."
Each of the plaintiffs - identified in the complaint as Fail, Scott Buchholz, Christian Andersonn, John Zonta, Stacey Truax, Timothy Melson, Scott Philbrick, and Jedadiah Zillmer, all of whom live in Colorado - say they followed the government's requirements in filing their claims, which included obtaining letters from independent physicians certifying that their "traumatic injuries" left each of them unable to work.
All of them; however, were denied their benefits.
"(A)ny member who receives an adverse TSGLI decision may obtain judicial review in any United States District Court of competent jurisdiction," the complaint states.
"In addition, even if administrative reviews were required of TSGLI applicants prior to initiating a lawsuit, doing so would be futile because it is certain that a TSGLI claim will be summarily denied on appeal for the reasons stated herein."
Government 'regularly' denies claims, lawyer's group says
According to the Veterans Administration (VA) Web site, to be eligible for TGSLI benefits:
- If injured on or after December 1, 2005, military personnel must be insured by SGLI when they experience a traumatic event. For those injured between October 7, 2001 and November 30, 2005, SGLI coverage is not required to be eligible for TSGLI.
- They must incur a covered loss and that loss must be a direct result of a traumatic injury (covered losses are listed here).
- They must have suffered the traumatic injury prior to midnight of the day that you separate from the uniformed services.
- They must have a scheduled loss within two years (730 days) of the traumatic injury.
- They must have survived for a period of not less than seven full days from the date of the traumatic injury.
The rules go onto state that "as long as the Servicemember experienced the traumatic event while in service and covered by SGLI, they can apply for the benefit even if they have since been discharged."
Similar lawsuits have been filed across the country.
The Republican National Lawyers Association says in one of its online newsletters that Congress created the TGSLI benefit as a way to "off-set the expenses of being traumatically wounded."
"But," the newsletter continues, "in some cases, soldiers must prove that they required assistance with particular "activities of daily living" in order to recover. The burden of proof is on the soldier. Often medical records from combat and field hospitals are unavailable, or woefully incomplete, and fellow soldier witnesses are difficult to track down."
"The military," the group says, "regularly denies TGSLI claims."
Sources:
http://www.courthousenews.com/2012/07/10/48219.htm
http://www.insurance.va.gov/sglisite/tsgli/TSGLIFAQ.htm#11
http://www.rnla.org/Newsletter/ViewArticle.asp?ArticleID=326
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