**September 28, 1978 CORRECTED COPY M29-1, Part III\
Change 2**

**CONTENTS**

**CHAPTER 8. DEATH CASE DECISIONS-NSLI AND USGLI**

PARAGRAPH PAGE

**SUBCHAPTER I. NSLI**

8.01 Adjudication Procedure 8-1\
8.02 Preliminary Processing 8-1\
8.03 Development 8-1\
8.04 Proof of Total Disability 8-2\
8.05 Maturity of Insurance Under 38 U.S.C. 713 8-2\
8.06 Preparation of VA Form 29-1565-3, Decision Disability Insurance
Benefits 8-2\
8.07 Notification of Action Taken 8-3

**SUBCHAPTER 2. USGLI**

8.08 Basic Requirements 8-3\
8.09 Development of Evidence 8-4\
8.10 Adjudication Procedure 8-4

8-i

**September 28, 1978 CORRECTED COPY M29-1, Part III\
Change 2**

**CHAPTER 8. DEATH CASE DECISIONS-NSLI AND USGLI**

**SUBCHAPTER 1. NSLI**

**8.01 ADJUDICATION PROCEDURE**

a\. When the claim is filed during the lifetime of the insured, and
before a determination is made on the claim for waiver of premiums, the
insurance matures because of death, the payment of the insurance
proceeds take precedence. The Death Claims Section after processing the
case, will refer the folder to the ICS (Insurance Claims Section) for
preparation of a paper diary, VA Form 29-5716b, DIC Diary
Card-NSLI-USGLI, for final determination on the pending claim for waiver
of premiums.

b\. If a disability waiver determination is necessary to place the
insurance in force at death, the Death Claims Section will refer the
case to ICS.

**8.02 PRELIMINARY PROCESSING**

a\. When the claim is filed during the lifetime of the insured, the
machine produced VA Form 29-1565-3, Decision Disability Insurance
Benefits, will be used.

b\. If the claim is filed after the death of the insured and the account
was active on the date of death, the General Clerk/Claims Examiner will
prepare VA Form 29-1565-3, completing the \"Claim No.\"\' contract
information and \"Premiums Paid To\" items obtaining the information
from the VA Form 29-368d, Report of Status for Settlement of Death
Claims. When the VA Fond 29-1565-3 is prepared by the General Clerk, it
will be referred with the insurance folder to the Claims Examiner.

c\. When the claim is filed after the death of the insured and the
account is lapsed, flee Adjustment Claims Clerk/Claims Examiner will
prepare VA Form 29-1565-3, completing the items mentioned above
including monthly premium rate.

d\. The Claims Examiner will check and compare the name, file number,
date of birth, claim/social security number, etc., on the VA Form
29-357, Claim for Disability Insurance Benefits, with records in the
insurance folder. Status of the insurance lapses and reinstatements,
etc., will also be checked. It should be verified that the claim is by
the beneficiary; or the estate of the beneficiary; or if the estate is
the beneficiary then by administrator, or the next of kin.

e\. The Claims Examiner will review the claim to determine the need for
initial development of evidence or if the evidence is sufficient to make
a decision. The case is either processed to completion or referred to an
Authorizer depending on the complexity of the case. (See ch. 2.)

**8.03 DEVELOPMENT**

a\. Instructions for developing a claim are outlined in chapters 2 and
3.

b\. The evidence required to establish TD (Total Disability) in death
cases, is the same as in live cases. The manner and sources from which
evidence is obtained is the same in either case.

**8-1**

**M29-1, Part III CORRECTED COPY September 28, 1978**

**Change 2**

c\. A paper diary, VA Form 29-5716b, will be prepared for a 45 day diary
for control of a pending claim since there is no insurance master record
on tape. The notation \"XC Case\" will be made in the right lower
portion of the form.

**8.04 PROOF OF TOTAL DISABILITY**

a\. When a claim for waiver of premiums is filed after the death of the
insured, evidence establishing TD for 6 consecutive months must be of
record in the VA within 1 year of the insured\'s death.

b\. If evidence is not received within l year from the date of death of
the insured, the claim will be disallowed.

c\. When the claimant is requested to furnish additional evidence,
he/she will be advised of flee time remaining in the 1-year limitation
period for the submission of such evidence.

d\. When there is timely evidence, but it is lacking only confirmation,
additional evidence for the purpose of such confirmation may be sought
and obtained even though the1-year period has expired. The question of
what is confirming evidence must be determined in each individual case.
when there is any doubt, the question should be resolved in favor of the
claimant.

**8.05 MATURITY OF INSURANCE UNDER 38 U.S.C. 713**

a\. When premiums cannot be waived under section 712, solely because the
insured died before total disability continued for 6 months, and
satisfactory proof of such fact is received within l year of the
insureds death, the insurance shall be deemed to be in force on the date
of death, and the unpaid premiums shall become a charge against the
proceeds of his/her insurance. (See 38 U.S.C. 714.)

b\. When a decision is rendered by ICS based on such facts, the VA Form
29-1565-3 will be prepared. In the award block enter the notation,
\"Payable under Section 713.\"

c\. After the decision is made, the case will be referred to the Death
Claims Section for payment of the proceeds.

**8.06 PREPARATION OF VA FORM 29-1565-3, DECISION DISABILITY INSURANCE
BENEFITS**

In preparing VA Form 29-1565-3 in a death case, the instructions listed
in chapter 4, paragraph 4.04a, will be followed with the exceptions
listed below:

Item Entry Required

Claim No. Enter a X before the c and number or XSS (Social\
Security) and number.

Diary Control Leave blank.\
Method of Premium Payment Leave blank.

**8-2**

**September 28, 1978 CORRECTED COPY M29-1, Part III\
Change 2**

Item Entry Required

Total or Total Permanent Disability Found

From Insert the commencing date of disability.\
To Insert the date of death.\
Follow-Up Date Leave blank.\
Severity Code Leave blank.\
Review Date Leave blank.\
Disability Classification Code Leave blank.\
Action Code Leave blank.\
Principal Occupation(s) Leave blank.\
Educational Background Leave blank.

8.07 NOTIFICATION OF ACTION TAKEN

a\. When the insured dies before completion of action on his or her
claim or when the claim is submitted by an eligible claimant, and such
claim is denied or partially denied, a certified letter will be sent to
the beneficiary, the administrator of the estate, or next of kin. An
appropriate letter will also be sent if the decision is favorable.

b\. If a claim for waiver under section 7I2 has not been filed, but
entitlement under section 713 is found no letter will be released by the
ICS.

c\. If the claim is disallowed, no certified letter will be sent;
however, an appropriate letter AT (automatic typewriter) will be
released to tile beneficiary, administrator of the estate, next of kin
or the claimant.

**SUBCHAPTER 2. USGLI**

**8.08 BASIC REQUIREMENTS**

a\. When no claim for TPD (Total Permanent Disability) insurance
benefits was filed during the lifetime of the veteran, and the insurance
was in force on the date of claim, or if the insurance had not been
canceled or reduced subsequent to July 2, 1926, a decision will not be
rendered. The claim will be disallowed.

b\. A claim for total disability income benefits will not be considered
under any circumstances unless the claim was filed prior to the death of
the insured or the beneficiary shows failure to file was due to
circumstances beyond the insured\'s control. Refer to M29-1, Part l
,chapter 32, paragraph 32.12a(10).

**8-3**

**M29-1, Part III CORRECTED COPY September 28, 1978**

**Change 2**

**8.09 DEVELOPMENT OF EVIDENCE**

Preliminary action on claims for disability insurance benefits in death
cases will be taken by the Authorizer. The evidence will be developed
and a decision rendered in the same manner as in cases in which the
veteran is alive.

**8.10 ADJUDICATION PROCEDURE**

a\. When the claim was filed alleging TPD for insurance purposes, and a
favorable or partially favorable decision is rendered after the death of
the insured under which the insurance matured by reason of TPD, ICS will
prepare VA Form 29-1 565-3, showing entitlement; however, award action
will not be taken.

b\. After the decision is approved and processed, persons entitled to
the benefit will riot be advised of

the action taken on the claim.

c\. The case will be forwarded to the Death Claims Section for all
further necessary action.

d\. If the decision results in a complete denial of the claim, a
disagreement letter (certified) will be sent to the beneficiary or other
person who would be entitled to the benefits if granted.

e\. Under the total disability provision, when the claim was filed prior
to the death of the veteran for TD insurance benefits (sec. 748) and the
decision is rendered after death, the claim will be adjudicated
substantially in accordance with the procedure for the adjudication of
such claim in cases in which the veteran is alive.

f\. Upon approval of the decision, the case will be processed as
provided in subparagraphs b and c above.

g\. If the claim is partially allowed or completely denied, the
Authorizer will release a letter (certified) to advise the beneficiary
of the action taken.

**8-4**