What Are TSGLI Benefits and How Do They Work?

If you’re an active duty military member or other service member who who suffered a severe injury, you may qualify to receive Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) benefits. But what are TSGLI benefits and how do they work?

TSGLI benefits are part of the service members’ traumatic injury prevention program. These critical benefits aim to provide service members with assistance when they sustain severe injuries outside the line of duty.

Suppose, for example, that you suffer severe injuries in a motorcycle accident, while helping a friend move furniture, or from an off-base adventure with your friends. You may have substantial long-term or even permanent limitations from those injuries.

TSGLI benefits can help eligible service members recover from traumatic injuries. They can help cover the increased expenses you may have from getting medical care and costs you have incurred dealing with your severe or permanent injuries. Although you may be automatically covered, you need a TSGLI injury lawyer to help you understand the benefits you could receive and ensure you get them.

When Do You Qualify for TSGLI?

TSGLI applies to service members who receive coverage through Servicemembers’ Group Life Insurance. If you already have SGLI coverage, you already have TSGLI coverage to go along with it.

People who can take advantage of SGLI and TSGLI include:

• Active duty service members
• National Guard service members
• Reservists

It may also apply to those serving funeral honors duty or one-day muster duty. You may receive retroactive tsgli payments if you suffered a traumatic injury between October 7, 2001 and November 30, 2005, regardless of where the injury occurred or whether coverage was available at the time.

To use TSGLI benefits, you cannot have self-inflicted injuries, including injuries caused by a suicide attempt. Otherwise, you should qualify to receive benefits no matter how the injury happened.

When Does TSGLI Kick In?

TSGLI kicks in when you suffer a traumatic injury as a service member. To use TSGLI coverage, you must fit these key elements:

• You have active SGLI coverage: If you have declined SGLI coverage, you likely do not have TSGLI benefits and cannot, therefore, use them to cover the cost of a traumatic injury. You cannot take out that coverage after receiving the injury.
• You have not yet separated from the Armed Forces: To use TSGLI coverage, you must serve as an active member of the Armed Forces. If you suffer your injuries after midnight on the day you separate from the Armed Forces, you may not have coverage.
• You survive for at least seven days after your accident: While SGLI benefits kick in if someone dies immediately, you will need to survive at least seven days after the accident to take advantage of TSGLI benefits or for your surviving family to take advantage of them.
• You suffer a scheduled loss within two years of your traumatic injury: Scheduled losses include permanent disability related to your traumatic accident. The extent of your scheduled loss may determine the compensation you can recover through your TSGLI benefits.

How Much Compensation Can You Recover Through TSGLI?

The amount of compensation you can recover through your TSGLI benefits will depend on what injuries you sustained, how your injuries occurred, and the long-term impact they have on your body. Some of the things TSGLI insurance covers for a qualifying traumatic injury include:

Total Loss of Sight: $50,000 per eye

Losing sight in one or both eyes can prove incredibly traumatic, not to mention limiting many of the activities you can engage in. If you lose your sight, you can recover $50,000 per eye through your TSGLI benefits. You must either suffer a permanent loss of sight or lose your sight for at least 120 days to claim those benefits.

Total Loss of Hearing: $25,000 for one ear; $100,000 for both ears

Hearing loss can be incredibly disorienting, even if you only lose hearing in one ear. Losing your hearing can change how you communicate and connect with people and make it very difficult for you to absorb any auditory warning. Through your TGLI benefits, you can recover increased compensation if you suffer a total loss of hearing in both ears.

Loss of Speech: $50,000

Loss of speech can occur in several ways. You may lose speaking ability due to trauma to the mouth and throat, or you might lose the ability to speak because of brain injury. Losing the ability to speak can make it very difficult to communicate your needs and wishes.

Paralysis: $100,000

Complete paralysis can mean life in a wheelchair and a long-term struggle to do things you once took for granted. In many cases, paralysis may result in the need for assistance with basic self-care tasks, including long-term care in your home.

TSGLI will pay out $100,000 for most types of paralysis, including:

• Quadriplegia (complete paralysis that impacts all four limbs)
• Hemiplegia (paralysis that impacts both the upper and lower limbs on one side of the body)
• Paraplegia (paralysis that affects the lower limbs on both sides)

On the other hand, if you suffer monoplegia, or paralysis of only one limb, you can recover $50,000 through your TSGLI benefits.

Burns: $100,000

If you suffer second-degree burns or worse to at least 20 percent of your body, including your face, or at least 20 percent of your face, you can recover compensation through your TSGLI insurance. Burns may cause severe pain and long-term scarring. In the case of severe burns, many victims may also suffer a loss of sensation due to nerve damage. Furthermore, in some cases, severe burns may impact mobility, particularly when they occur near joints.

Amputation of Hand or Fingers: $50,000

To claim compensation for hand or finger amputation, you must lose:

• The hand at or above the wrist
• All four fingers on one hand
• The thumb on one hand

Hand amputation can interfere with dexterity and make it very difficult to engage in many activities, including activities like self-care. The resulting loss of dexterity may also interfere with future work prospects.

Amputation of Foot or Toes: $50,000

To qualify for TSGLI compensation for the amputation of your foot or toes, you will need to lose either your foot at or above the ankle or all the toes, including the big toe, on one foot.

If you have your big toe or all four other toes amputated from one foot, you may receive as much as $25,000 in compensation. Foot or toe amputation can interfere heavily with balance and mobility and may interfere with some of the activities, including leisure activities, that you would usually enjoy.

Limb Salvage: $50,000

In some cases, you may need many surgeries and procedures intended to save a limb that would otherwise require amputation. Often, amputation can offer more freedom of mobility and less pain than limb salvage. However, many people prefer to keep their organic limbs for cosmetic or functional purposes, if possible. If you opt for limb reconstruction in place of amputation, you may have the right to use your TSGLI benefits for compensation.

Facial Reconstruction: $25,000-$75,000

Severe injury to the face may require complex facial reconstruction, including reconstruction of the jaw ($75,000), nose ($50,000), lips ($50,000 for one; $75,000 for both) or eyes ($25,000).

Facial reconstruction can prove incredibly painful and may represent a long road to recovery for many patients. Furthermore, facial reconstruction may result in long-term scarring or permanent changes to facial appearance, which can be traumatic for many patients.

Facial reconstruction may also mean considerable time away from work or the inability to engage in your usual preferred leisure activities.

Coma from Traumatic Brain Injury: Based on Length of Coma/ADL Loss

To determine the compensation for a coma from a traumatic injury or brain injury, you must consider the number of days of disability suffered because of the coma.

If you suffer a brain injury or coma, you will receive:

• $25,000 at the 15th consecutive day of coma
• $50,000 at the 30th consecutive day of coma
• $75,000 at the 60th consecutive day of coma
• $100,000 at the 90th consecutive day of coma

In addition to considering time spent in a coma directly, TSGLI benefits may also look at brain injuries that impact your ability to engage in activities of daily living. If you cannot take care of at least two activities of daily living including basic self-care and grooming, dressing, walking, and eating, for at least 15 consecutive days—you may recover the same compensation that you would if your brain injury kept you in a coma.

Furthermore, if you end up with a brain injury, you can recover $25,000 in compensation after 15 consecutive days of hospitalization. The payment for hospitalization replaces the payment for the first 15 consecutive days of coma, in cases of extended coma.

Brain injury can impact every area of your life, making it difficult for you to concentrate, take care of yourself, and even engage in the leisure activities you enjoy. When it impacts activities of daily living, including your ability to take care of yourself, you can recover considerable compensation for those losses, which may make it easier for you to take care of your financial needs while you recover from your injuries.

Damage to the Genitals

If you suffer damage to your genitals in a traumatic accident, TSGLI may provide compensation.

This compensation may include:

• $50,000 for the loss of the penis, including amputation of any portion of the shaft
• $50,000 for permanent loss of the use of the penis
• $25,000 for the loss of one testicle
• $50,000 for the loss of both testicles
• $50,000 for the loss of the vulva, uterus, or vaginal canal, or for the permanent loss of the use of those organs
• $25,000 for the loss of one ovary
• $50,000 for the loss of both ovaries, or the loss of the use of both ovaries
• $50,000 for the permanent loss of urinary system function

Payment for Hospitalization Due to Traumatic Injury

If you have suffered an immense traumatic injury that requires substantial hospitalization, you may have the right to seek up to $25,000 in compensation through your TSGLI benefits. Benefits may cover inpatient hospital care at rehabilitation facilities, critical care facilities, and skilled nursing facilities. Expanded TSGLI benefits may also cover surgical treatment, such as limb reconstruction surgeries.

Traumatic Injury That Impacts Activities of Daily Living

Sometimes, you may suffer an injury not named in the specific schedule of compensation that you can recover through your TSGLI benefits. Although you cannot find that particular condition on the list, you may still have the right to recover considerable compensation for those losses. TSGLI benefits for those unnamed injuries may include those that impact your ability to perform the normal activities of daily living.

TSGLI standards name six key activities of daily living:

• Bathing
• Continence
• Dressing
• Eating
• Toileting
• Transferring

Suppose you require either physical assistance, which means hands-on assistance from another person, stand-by assistance, which requires another person on hand to ensure that you can complete those activities without injury, or verbal assistance, in which you need someone else to guide you through a common task that, under normal circumstances, you would take care of yourself.

In that case, you may seek compensation through TSGLI benefits for those losses. At 15 days of impact to activities of daily living, you can receive $25,000 in compensation. You can recover $25,000 for each 15 days of impact thereafter, up to $100,000.

TSGLI Maximums

TSGLI can provide much-needed compensation to service members who have sustained severe injuries outside their military responsibilities. However, TSGLI benefits do have strict limits. TSGLI caps at $100,000 in compensation, regardless of the extent of your injuries. You may also not have the right to claim TSGLI benefits for the same injury more than once, even if it has an impact under two or more named categories.

Contact an Attorney to Learn More

Understanding TSGLI benefits can be incredibly complicated, especially when it comes to the specifics of individual injuries and how the Department of Veterans Affairs defines specific losses.

If you have questions about the compensation you may deserve for the injuries you have sustained, including how those maximum benefits may affect your ability to recover compensation for your injuries, a lawyer can help. Contact a TSGLI attorney at Lucas, Macyszyn & Dyer Law Firm as soon after your accident as possible to ask questions about your TSGLI benefits and to uncover more about the compensation you may deserve.