TSGLI Schedule of Losses, Servicemembers' and Veterans' Group Life Insurance (U.S. Department of Veterans Affairs)

TSGLI Schedule of Losses

For losses listed in Part I, multiple injuries resulting from a single traumatic event may be combined with each other and treated as one loss for purposes of a single payment (except where noted otherwise), however, the total payment amount MAY NOT exceed $100,000.

For losses listed in Part II, payment amounts MAY NOT be combined with payment amounts in Part I - only the higher amount will be paid. The total payment amount MAY NOT exceed $100,000 for multiple injuries resulting from a single traumatic event.

Part I
	Loss	Payment Amount
1.	Sight: Total and permanent loss of sight OR loss of sight that has lasted 120 days For each eye view TSGLI standard for loss of sight	$50,000
2.	Hearing: Total and permanent loss of hearing For one ear For both ears view TSGLI standard for loss of hearing	$25,000 $100,000
3.	Speech: Total and permanent loss of speech view TSGLI standard for loss of speech	$50,000
4.	Quadriplegia: complete paralysis of all four limbs view TSGLI standard for paralysis	$100,000
5.	Hemiplegia: complete paralysis of the upper and lower limbs on one side of the body view TSGLI standard for paralysis	$100,000
6.	Paraplegia: complete paralysis of both lower limbs view TSGLI standard for paralysis	$100,000
7.	Uniplegia: complete paralysis of one limb* *Note: Payment for uniplegia of arm cannot be combined with loss 9, 10 or 14 for the same arm. Payment for uniplegia of leg cannot be combined with loss 11, 12, 13 or 15 for the same leg. view TSGLI standard for paralysis	$50,000
8.	Burns: 2nd degree or worse burns to at least 20% of the body including the face OR, at least 20% of the face view TSGLI standard for burns	$100,000
9.	Amputation of hand: Amputation at or above the wrist For each hand* *Note: Payment for loss 9 cannot be combined with payment for loss 10 for the same hand. view TSGLI standard for amputation of hand	$50,000
10.	Amputation of 4 fingers on 1 hand OR thumb alone: Amputation at or above the metacarpophalangeal joint For each hand view TSGLI standard for amputation of fingers/thumb	$50,000
11.	Amputation of foot: Amputation at or above the ankle For each foot* *Note: Payment for loss 11 cannot be combined with payments for losses 12 or 13 for the same foot. view TSGLI standard for amputation of foot	$50,000
12.	Amputation of all toes including the big toe on 1 foot: Amputation at or above the metatarsophalangeal joint For each foot *Note: Payment for loss 12 cannot be combined with payments for loss 13 for the same foot. view TSGLI standard for amputation of toes	$50,000
13.	Amputation of big toe only, OR other 4 toes on 1 foot: Amputation at or above the metatarsophalangeal joint For each foot view TSGLI standard for amputation of toes	$25,000
14.	Limb salvage of arm: Salvage of arm in place of amputation For each arm* *Note: Payment for loss 14 cannot be combined with payments for losses 9 or 10 for the same arm. view TSGLI standard for limb salvage	$50,000
15.	Limb salvage of leg: Salvage of leg in place of amputation For each leg* *Note: Payment for loss 15 cannot be combined with payments for losses 11, 12 or 13 for the same leg. view TSGLI standard for limb salvage	$50,000
16.	Facial Reconstruction – reconstructive surgery to correct traumatic avulsions of the face or jaw that cause discontinuity defects.
	Jaw – surgery to correct discontinuity loss of the upper or lower jaw	$75,000
	Nose – surgery to correct discontinuity loss of 50% or more of the cartilaginous nose	$50,000
	Lips – surgery to correct discontinuity loss of 50% or more of the upper or lower lip For one lip For both lips	$50,000 $75,000
	Eyes – surgery to correct discontinuity loss of 30% or more of the periorbita For each eye	$25,000
	Facial Tissue – surgery to correct discontinuity loss of the tissue in 50% or more of any of the following facial subunits: forehead, temple, zygomatic, mandibular, infraorbital or chin. For each facial subunit	$25,000
	Note 1: Injuries listed under facial reconstruction may be combined with each other, but the maximum benefit for facial reconstruction may not exceed $75,000. Note 2: Any injury or combination of injuries under facial reconstruction may also be combined with other injuries listed in Part I and treated as one loss, provided that all injuries are the result of a single traumatic event. However, the total payment amount may not exceed $100,000. view TSGLI standard for facial reconstruction
17.	Coma from traumatic injury AND/OR Traumatic Brain Injury resulting in inability to perform at least 2 Activities of Daily Living (ADL) at 15th consecutive day of coma or ADL loss at 30th consecutive day of coma or ADL loss at 60th consecutive day of coma or ADL loss at 90th consecutive day of coma or ADL loss view TSGLI standard for coma/TBI	$25,000 an additional $25,000 an additional $25,000 an additional $25,000
18.	Hospitalization due to traumatic brain injury at 15th consecutive day of hospitalization Note 1: Payment for hospitalization replaces the first payment period in loss 17. Note 2: Duration of hospitalization includes dates on which member is transported from the injury site to a facility described in § 9.20(e)(6)(xiii), admitted to the facility, transferred between facilities, and discharged from the facility. view TSGLI standard for hospitalization due to TBI	$25,000

Part II

Loss

Payment
Amount

19.

Traumatic injury resulting in inability to perform at least 2 Activities of Daily Living (ADL)

at 30th consecutive day of ADL loss
at 60th consecutive day of ADL loss
at 90th consecutive day of ADL loss
at 120th consecutive day of ADL loss

view TSGLI standard for loss of ADL

$25,000
an additional $25,000
an additional $25,000
an additional $25,000

20.

Hospitalization due to traumatic injury

at 15th consecutive day of hospitalization

Note 1: Payment for hospitalization replaces the first payment period in loss 19.
Note 2: Duration of hospitalization includes dates on which member is transported from the injury site to a facility described in § 9.20(e)(6)(xiii), admitted to the facility, transferred between facilities, and discharged from the facility.

view TSGLI standard for hospitalization due to traumatic injury

$25,000

Reviewed/Updated Date: December 29, 2008

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