VA life insurance reject

[skippy13]

I got a letter from the VA life insurance I had applied for and they rejected me because of my "back problem" I get SSDI for. Huh?? I didn't think that they could refuse to cover you for medical issues that are not (hopefully) fatal. Should I appeal or would I get hyped up over nothing with no chance of success?

[Veteran Advisor]

I got a letter from the VA life insurance I had applied for and they rejected me because of my "back problem" I get SSDI for. Huh?? I didn't think that they could refuse to cover you for medical issues that are not (hopefully) fatal. Should I appeal or would I get hyped up over nothing with no chance of success?

Skippy,

The only life insurance I am aware of offered through the VA is Service Disabled Life Insurance (RH insurance). The other insurances offered to vets are VGLI (for those who roll over their SGLI immediately after discharge) and TSGLI for those catastrophically injured in service after 12/1/05. Which one did you apply for?

[skippy13]

It is the RH insurance. I am 100% sc, but also have a disability (hence the SSDI) that is not service connected. They say my non SC disability disqualifies me from obtaining insurance because I am not a good risk. They say I am not in good health and have a "disease, deformity or injury or abnormality that would tend to weaken or impair the normal functions of the mind or body or shorten life". Yeah, so? It may be ugly, but it aint fatal!

[Veteran Advisor]

It is the RH insurance. I am 100% sc, but also have a disability (hence the SSDI) that is not service connected. They say my non SC disability disqualifies me from obtaining insurance because I am not a good risk. They say I am not in good health and have a "disease, deformity or injury or abnormality that would tend to weaken or impair the normal functions of the mind or body or shorten life". Yeah, so? It may be ugly, but it aint fatal!

You are entitled to premium-free RH insurance for your service connected permanent and total disability, but you must apply within 2 years of receiving that rating. Otherwise, you'll have to seek and obtain service connection for a new condition in order to restart your eligibility period. I'm in that boat right now because I didn't apply for RH insurance within the 2-year window following my 100% rating. You cannot become re-eligible based on a non-service connected condition, which appears to be what you were attempting to do. I'm not sure why any mention of risk was contained in your letter because entitlement is based on service connection not state of health.

[skippy13]

I know that it is based on SC, not on any other condition and that is why I applied since they sent me the paperwork. I am not applying for the insurance based on a non SC condition, but they take all other conditions along with your SC condition into account apparently. They are saying that I have another condition that is not SC that disqualified me. I was not applying based on a non SC condition, but had to include my non SC on the application under general health questions.

I have been SC 100% only since last Nov. 2008. I don't know why they take into consideration any other conditions that I may have that are not SC, but they did.

Is there a rule stating that they are or are not allowed to take your other non SC conditions into consideration and then use it to disqualify a person? I could use the actual rule number if anyone can find it. I have to file an NOD, and the actual rule number would be helpful.

[Veteran Advisor]

I know that it is based on SC, not on any other condition and that is why I applied since they sent me the paperwork. I am not applying for the insurance based on a non SC condition, but they take all other conditions along with your SC condition into account apparently. They are saying that I have another condition that is not SC that disqualified me. I was not applying based on a non SC condition, but had to include my non SC on the application under general health questions.

I have been SC 100% only since last Nov. 2008. I don't know why they take into consideration any other conditions that I may have that are not SC, but they did.

Is there a rule stating that they are or are not allowed to take your other non SC conditions into consideration and then use it to disqualify a person? I could use the actual rule number if anyone can find it. I have to file an NOD, and the actual rule number would be helpful.

Skippy,

I stand corrected. According to the VA's guidance on eligibility, vets may apply for RH Insurance if they meet the following 4 criteria:

1. Released from active service on or
after April 25, 1951.
2. Released under other than dishonorable conditions.
3. Have a service-connected disability.
4. Apply within 2 years from the date VA
grants your new service-connected disability.

But the VA, as you found out, does add one more criterion, stating that you must be in good health, except for your service-connected disability(ies).

[skippy13]

Thanks Vet Adv...I will try to file the NOD. I hate lobbing paper grenades at the VA or anyone else, but I will try to get this through. I am in overall good health. As we all know having a SCI is not fatal for the most part. I will wait until I ave this next surgery on C4/5 and 6/7. (Just in case ;))

[Veteran Advisor]

Thanks Vet Adv...I will try to file the NOD. I hate lobbing paper grenades at the VA or anyone else, but I will try to get this through. I am in overall good health. As we all know having a SCI is not fatal for the most part. I will wait until I ave this next surgery on C4/5 and 6/7. (Just in case ;))

Skippy,

Go for it! If I were you I'd try to find a doctor who could write a statement either about your state of good health or, at a minimum, your longevity. Having an SCI is no longer the death warrant it used to be in most cases. Also, explore challenging whether VA has sufficiently identified adequate grounds for denial based on its findings. Did a doctor find against your favor or was it some VA bureaucrat? Is there any ambiguity you can exploit (reasonable doubt must be resolved in favor of the vet; see the “benefit of the doubt rule” under Title 38 U.S.C. § 5107). It's a Hail Mary shot but nonetheless a shot.

Gunner

[Timo]

I am little (or very) confuse about the life insurance. Does Tim have to apply for RH insurance?
Do I understand this correctly: When Tim was a US Marine, he had SGLI. Now he is a Veteran as of March 30 this year, they extend SGLI for 2 more years and then it will roll to VGLI and he has to pay the premium.

[quadvet]

Bump, I'd like to know the answer to this, too, Timo... Veteran Adviser?

[Veteran Advisor]

I am little (or very) confuse about the life insurance. Does Tim have to apply for RH insurance?
Do I understand this correctly: When Tim was a US Marine, he had SGLI. Now he is a Veteran as of March 30 this year, they extend SGLI for 2 more years and then it will roll to VGLI and he has to pay the premium.

Tim's VGLI entitlement flows from his SGLI entitlement. He'll need to apply within the application period, basically after his SGLI coverage expires, or lose his opportunity to receive VGLI forever.

However, RH Insurance is an altogether different matter. Where RH, or Service-Disabled, Insurance is premium-free life insurance based on service connection, VGLI is just based on being a veteran.

RH Insurance gives a veteran $25K in coverage with the option to pay a premium for extra coverage in $1K increments. He'll have two years from the date of his service connection to apply for RH insurance.

I always advise vets to get both VGLI and RH Insurance if eligible for both.

[quadvet]

I always advise vets to get both VGLI and RH Insurance if eligible for both.Who would a veteran talk to, to ensure they receive both insurance policies, while still eligible?

How does an old timer like myself know what coverage I have? :thinking:

Thanks again, Veteran Advisor. :thumb:

[Veteran Advisor]

Who would a veteran talk to, to ensure they receive both insurance policies, while still eligible?

How does an old timer like myself know what coverage I have? :thinking:

Thanks again, Veteran Advisor. :thumb:

QV, If you had a VGLI policy, you'd be getting a quarterly bill from the Office of Servicemembers' Group Life Insurance. The number is 1-800-419-1473.

For Timo, you must apply for VGLI within one year and 120 days from discharge. However, service members who submit their application within 120 days of discharge do not need to submit evidence of good health. Service members who apply after the 120-day period must submit evidence of good health. As for the SGLI extension, yes, it was moved to 2 years after discharge in July 2008.

RH Insurance policies are administered through the VA. You can call your local VA Regional Office to find out if you have a policy.

[skippy13]

Who would a veteran talk to, to ensure they receive both insurance policies, while still eligible?

How does an old timer like myself know what coverage I have? :thinking:

Thanks again, Veteran Advisor. :thumb:

I just hope they don't hold your "condition" against you the way they did me, QV. Sucks.

[quadvet]

QV, If you had a VGLI policy, you'd be getting a quarterly bill from the Office of Servicemembers' Group Life Insurance. The number is 1-800-419-1473.

RH Insurance policies are administered through the VA. You can call your local VA Regional Office to find out if you have a policy.Doh, yes, I have VGLI, just always forget because $10k ain't much to remember!

I'll have to check on the RH insurance, first I've heard of it, thanks.

I just hope they don't hold your "condition" against you the way they did me, QV. Sucks.I don't follow what disqualified you... but I'm sure if there's a way, they'll find it! Bummer, sorry, Skippy.

[Timo]

This is what we received from VA Regional Office and Insurance Center in Philadelphia:
Free Coverage for up to Two years from Discharge: due to your disabilities, you qualify for a free extension of your SGLI coverage through March 20, 2011. All you have to do is complete and return the enclosed application as soon as possible....
VGLI Coverage: Once your free coverage ends you will automatically be issued VGLI for the same level of coverage you have under SGLI, unless you choose a lesser amount. VGLI is term insurance that you can keep for the rest of your life without ever having to prove you are in good health....
You will receive a bill the frist month's VGLI premium approximately one moth prior to when you SGLI coverage expires.
Service_Disabled Veterans' Insurance: Due to your service connected disabilities, you are also eligible for $10,000 of S-DVI coverage supplement your extended SGLI and VGLI coverage.

I assume Tim has a life insurance coverage.

[quadvet]

Bump, for Timo, and veterans out there who might have the same question.

Veteran Adviser, can you confirm that is Tim on the right track here with his life insurance policies?

Thanks much,

Quadvet

This is what we received from VA Regional Office and Insurance Center in Philadelphia:
Free Coverage for up to Two years from Discharge: due to your disabilities, you qualify for a free extension of your SGLI coverage through March 20, 2011. All you have to do is complete and return the enclosed application as soon as possible....
VGLI Coverage: Once your free coverage ends you will automatically be issued VGLI for the same level of coverage you have under SGLI, unless you choose a lesser amount. VGLI is term insurance that you can keep for the rest of your life without ever having to prove you are in good health....
You will receive a bill the frist month's VGLI premium approximately one moth prior to when you SGLI coverage expires.
Service_Disabled Veterans' Insurance: Due to your service connected disabilities, you are also eligible for $10,000 of S-DVI coverage supplement your extended SGLI and VGLI coverage.

I assume Tim has a life insurance coverage.

[Veteran Advisor]

This is what we received from VA Regional Office and Insurance Center in Philadelphia:
Free Coverage for up to Two years from Discharge: due to your disabilities, you qualify for a free extension of your SGLI coverage through March 20, 2011. All you have to do is complete and return the enclosed application as soon as possible....
VGLI Coverage: Once your free coverage ends you will automatically be issued VGLI for the same level of coverage you have under SGLI, unless you choose a lesser amount. VGLI is term insurance that you can keep for the rest of your life without ever having to prove you are in good health....
You will receive a bill the frist month's VGLI premium approximately one moth prior to when you SGLI coverage expires.
Service_Disabled Veterans' Insurance: Due to your service connected disabilities, you are also eligible for $10,000 of S-DVI coverage supplement your extended SGLI and VGLI coverage.

I assume Tim has a life insurance coverage.

Based on the info provided here, it sounds like Tim is covered under SGLI. After his two year SGLI-eligibility period ends he will be automatically covered under VGLI at his option (vets do have to pay a premium for this coverage).

He is not covered by SDVI unless he submits the proper forms to the VA within the 2-year period following his date of service connection. He will also have to submit the form to have his premium waived given his 100% service connection. Vets with less than 100% service connection have to pay a premium for SDVI.

Also, if Tim wants to supplement his coverage with an additional VA policy that goes over the premium-free $10,000 SDVI coverage, he can apply for the SDVI Supplemental (in $1000 increments), which is not premium free and is based on age.

By the way, SDVI and RH Insurance are the same thing, in case I didn't make that clear.

[quadvet]

Thanks for that, Veteran Advisor, I'm sure our silent brothers and sisters are also benefiting from your insightful posts.

[Timo]

Thanks Veteran Advisor and Quadvet. I will print this session out so Tim and my husband can read.