Military Health, Tricare programs - Military Times

Retroactive payouts for traumatic injuries

New rules for receiving up to $100,000 in traumatic injury insurance payments for service members facing long and arduous recovery and rehabilitation were updated and expanded, effective Nov. 26.

Officials estimate about 1,600 service members and veterans will get retroactive payments under the new rules, published in the Nov. 26 Federal Register. The average retroactive payment is expected to be $32,000, but some people will get the maximum $100,000 payout.

Traumatic injury insurance, created in 2005 for Iraq and Afghanistan veterans and later expanded to cover all serious injuries incurred in the line of duty but outside of combat, has undergone many changes as officials have grappled with how best to provide temporary compensation to people with life-changing injuries.

The policy applies to qualifying injuries incurred in operations Enduring Freedom and Iraqi Freedom as of Oct. 7, 2001, and to injuries outside the combat zones as of Dec. 1, 2005. Such changes require Veterans Affairs, which administers the program, to hold a 30-day comment period before issuing final rules so tweaks may be made.

Three-fourths of the retroactive payments will result from a change in coverage regarding traumatic brain injuries. Under the new rules, being hospitalized for 15 consecutive days for TBI will result in a $25,000 payment. Previously, that situation was not specifically covered.

Some of the changes stem from complaints from wounded troops; others result from discussions with medical personnel who treat the wounded, VA officials said.

For example, VA found that doctors are reluctant to label the loss of sight, speech and hearing as permanent. So the new rules define “permanent” for purposes of traumatic injury insurance. In the case of the loss of sight, the new rules specify that being unable to see for 120 days or longer qualifies for a $50,000 payment for each eye, even if future cornea surgery might restore some vision.

Although amputations previously qualified as traumatic injuries, the revised rules expand this area to cover partial amputation, limb salvage where major surgery is done in an attempt to save an arm or leg, and irreversible paralysis of a limb.

Post-service amputations are another new addition to the program. Coverage generally has been limited to amputations that occur while someone is in the military and covered by Servicemembers’ Group Life Insurance. But now a veteran who suffers a severe limb injury while in service could get a payment if the limb is amputated after separation.

One restrictive change states that a traumatic event must be an actual injury, not a medical procedure, to qualify for payments. Injuries caused by preventive procedures — inoculations, for example — are not covered. This change will not lead to retroactive denial of any previous payments, officials said.

More information:

Download a complete list of injuries and payments