MILPERSMAN 1770-250 _FSGLI_ CLAIM by yaofenji

VIEWS: 47 PAGES: 4

									                                                          1770-250
                                                CH-22, 13 Feb 2008
                                                       Page 1 of 4

                   MILPERSMAN 1770-250

REPORTING DEATH OF NAVAL DEPENDENTS AND SUBMISSION
OF FAMILY SERVICEMEMBERS’ GROUP LIFE INSURANCE
(FSGLI) CLAIM
Responsible CNO            Phone:            DSN         882-2501
Office      (N135C)        TOLL FREE WITHIN U.S.   (800) 368-3202
                                            COMM   (901) 874-2501
                                             FAX   (901) 874-2265


References   (a) P.L. 107-14, 5 Jun 01
             (b) NAVADMIN 281/01
             (c) NAVADMIN 317/02


Forms        1.   NAVPERS 1070-602 (07-72), Dependency
                  Application/Record of Emergency Data
             2.   SGLV-8283A (9-07), Claim for Family Coverage
                  Death Benefits

1. Purpose. This article provides procedures for reporting
the death of a servicemember’s dependent and submission of a
claim when covered by Family Servicemembers' Group Life
Insurance (FSGLI) (see references (a), (b), and (c); and
MILPERSMAN 1741-020).

2. Reporting Requirement for Dependents. The Active Duty or
Navy Reserve member's commanding officer (CO) is responsible for
submitting a casualty report. The report should be submitted
via E-Mail to MILL_NavyCasualty@navy.mil. The message should
indicate the servicemember’s name, rank, and social security
number (SSN) (XXX-XX-1234, last four digits) in the subject
line.

3. Initial Reporting of Dependent Deaths.    The message should
contain the following information:

    a. Dependent’s name/SSN (XXX-XX-1234, last four
digits)/relationship to servicemember.
                                                                1770-250
                                                      CH-22, 13 Feb 2008
                                                             Page 2 of 4

    b. Command representative assisting the servicemember:
name/rank/phone/facsimile (fax)/E-Mail.

    c.   Specify “Dependent Death.”

    d.   Specify date of death/place/circumstances.

    e.   Location of remains.

    f. Specify if the deceased dependent was insured under the
FSGLI program. If the deceased dependent was a spouse, specify
the amount of Servicemembers’ Group Life Insurance (SGLI)
coverage the servicemember maintained. If unknown, so state.

    g.   Date/time servicemember was notified of dependent's
death.

    h.   Any remarks required or desired by command.

4. Example Format for Naval Dependent Death Personnel Casualty
Report (PCR). (Use proper message format.)

FM PERSUPPACTLANT NORFOLK VA//N00//
TO COMNAVPERSCOM MILLINGTON TN//PERS62//
INFO CNI WASHINGTON DC//JJJ//
PERSUPP DET NEW LONDON CT
UNCLASS//N01770//
MSGID/GENADMIN/PERSUPPACTLANT NORFOLK VA//
SUBJ/REPORT OF DEPENDENT DEATH ICO CT1(AW) MACINERNV, SCOTT M. USN,
XXX-XX-1234//
REF/A/DOC/MILPERSMAN ARTICLE 1770-250/__ ___ 08)//
AMPN/REF A IS REPORTING DEATH OF NAVAL DEPENDENTS AND SUBMISSION OF FAMILY
SERVICEMEMBERS’ GROUP LIFE INSURANCE (FSGLI) CLAIM//
RMKS/1. FOLLOWING INFO SUBMITTED PER REF A:
A. DEPENDENT INFO: MACINERNV, MICHELLE, XXX-XX-5678, DAUGHTER, DOB
1988JUL08.
B. POC: CTC (SW/AW) PAUL IKERMAN, WORK (518) 583-1901 CELL (518) 322-6447
FAX (518) 583-1029, EMAIL: PAUL.IKERMAN@NAVY.MIL.
C. DEPENDENT DEATH.
D. DATE OF DEATH: 10 MAY 2007. PLACE OF DEATH: 2B DOLPHIN TERRACE JACKSON
SPRINGS, NV 12866. CIRCUMSTANCES: AT APPROX 0001, 10 MAY 2007, FAMILY
MEMBER WAS INVOLVED IN A FATAL TRAFFIC ACCIDENT.
E. LOCATION OF REMAINS: JACKSON HOSPITAL, JACKSON SPRINGS NV 12866.
F. FSGLI: DEPENDENT IS INSURED UNDER FSGLI.
G. MEMBER NOTIFIED 10 MAY 08 1800.
H. ADDITIONAL REMARKS.

5. Required Documentation in Dependent Death Cases. The
following items are required for FSGLI claims processing:
                                                         1770-250
                                               CH-22, 13 Feb 2008
                                                      Page 3 of 4

    a. SGLV-8283A: Must be completed and signed by the
servicemember. This form may be obtained online at
http://www.npc.navy.mil/CommandSupport/CasualtyAssistance/General
Info/PERS_62_Forms.htm or www.insurance.va.gov.

    b. NAVPERS 1070/602: Copy of servicemember’s latest
NAVPERS 1070/602 showing dependency. NOTE: In the case of
infant death where the child is less than 120 days old, an
official State-issued birth certificate is required.

    c. Death Certificate: Final death certificate specifying
cause of death. NOTE: Servicemember’s branch of service is
required to rule out beneficiary involvement in wrongful death.
If final death certificate is unduly delayed, command point of
contact (POC) should contact Chief of Naval Operations (CNO),
Navy Casualty Assistance Division (N135C) to pursue other means
by which to rule out beneficiary involvement.

    d. For Spousal Deaths: In the case of spousal deaths, the
servicemember’s Leave and Earning Statement will be required to
show proof of premium payments.

    e. For Child 18 Years of Age or Older: In the case of a
child 18 years of age or older, evidence that

        (1) the child was, before attaining age 18, declared
permanently incapable of self-support; or

        (2) evidence stating the child was 22 or below and
actively pursuing a course of instruction at an approved
educational institution. Acceptable evidence is a death
certificate listing “student” in the occupation block or a letter
from the education institution, on their letterhead, that the
child was enrolled.
                                                          1770-250
                                                CH-22, 13 Feb 2008
                                                       Page 4 of 4

6. Claim Processing in Dependent Death Cases.   Applicable items
should be transmitted by fax to:

       CNO, Navy Casualty Assistance Division (N135C)
       COMM (901) 874-2265, DSN 882-2265

Upon receipt of all applicable items, CNO (N135C) will certify,
validate, and forward required documentation to the Office of
Servicemembers' Group Life Insurance (OSGLI) for final
determination of eligibility and payment.

7. Dependent Child Death of Dual Military Parents/Stepparents.
Per reference (a), coverage is available only to one member.
Payments under this paragraph are determined on a case-by-case
basis. Servicemembers are encouraged to contact CNO (N135C) for
additional guidance on claim submission.

8. Beneficiary Involvement. If it is determined by competent
authority that the beneficiary was involved in the wrongful
death of the insured, payment of claim will be determined by
OSGLI on a case-by-case basis.

								
To top