What Should I Do if My TSGLI Claim Was Denied?

Published On: October 20, 2021
Categories: Bad Faith Insurance

As a service member, you have worked and fought for your country. Following serious injuries, whether in the line of duty or outside your usual responsibilities, you may have assumed that you could receive much-needed financial support and compensation for your injuries from your Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) coverage.

Then it happened: You received a claim denial letter in the mail for your TSGLI claim, letting you know that you could not recover the compensation you deserve for your injuries.

What comes next? How can you manage the aftermath of those injuries and seek the compensation you really deserve?

How Much Compensation Can You Recover Under TSGLI?

TSGLI provides financial compensation based on the specific losses suffered by the service member. It offers up to $100,000 in compensation for any severe losses suffered by the service member. Even if you suffered more than one type of injury during the same incident, you may receive only $100,000 in compensation for a single incident that resulted in permanent loss or disability.

Compensation starts at $25,000 for the amputation of a single big toe or all four other toes on one foot, eye surgery, or facial injuries, including injuries that result in facial reconstructions, and rises to $100,000 for injuries like burns and paralysis.

Unfortunately, the VA often fails to pay out the compensation that victims really deserve for those injuries. They may try to minimize the compensation you deserve for your injuries, although the scheduled loss standards clearly lay out what compensation you should expect for the injuries you sustained, even if you did not sustain them in the line of duty or during a military-sponsored activity.

Sometimes, the VA may deny your claim for what seems like no reason at all.

Do You Qualify for TSGLI Benefits?

TSGLI benefit eligibility must meet several clear requirements. Note that TSGLI coverage does not require your injury to occur in the line of duty. In fact, you can claim TSGLI benefits any time you sustain serious benefits, including incidents that occur while on leave. To quality, however, you must meet the criteria named by the VA.

If you do not meet those criteria, the VA may deny your claim. However, in some cases, exceptions exist that can help increase the compensation you can recover for your injuries. Working with an attorney can help you identify those exceptions and determine how much compensation you may really deserve for those injuries.

In general, you are eligible for TSGLI benefits, and therefore should expect financial compensation for your injuries, if you meet these criteria.

You suffered a scheduled loss as a result of a traumatic injury.

Scheduled losses include anything from spinal cord injuries to the loss of a limb, loss of hearing, or an injury that interferes permanently with the ability to speak. The more serious your injury, the greater the compensation you can usually recover through TSGLI.

To claim compensation, however, you must suffer a scheduled loss: something that qualifies as a long-term or permanent disability. You would not, for example, claim compensation through TSGLI if you suffered an injury that temporarily reduced your hearing, but that allowed it to return quickly over time.

Your scheduled loss occurred within two years of the date of the traumatic injury.

To claim compensation, the loss must have occurred no more than two years after the incident that led to the loss. Suppose, for example, that you suffered injuries in a motorcycle accident. Afterward, you assumed that you would return to normal activity, and healing went on as usual.

More than two years later, you ended up having to have a limb amputated because of complications from the injury, including lack of blood flow or severe infection. In those cases, you might not have the right to claim compensation through TSGLI, since the loss occurred so long after the traumatic injury.

Your injury occurred before midnight on the day you left the military.

To claim TSGLI, you must serve as a member of the Armed Forces, including the Army, Navy, Marine Corps, Coast Guard, or National Guard, or Space Force. If you had already separated from the Armed Forces at the time of the incident, whether due to planned retirement/honorable discharge, dishonorable discharge, or some other reason, you may no longer have the right to file for assistance through the TSGLI program.

You survived at least seven days after the accident occurred.

Sometimes, the victim’s survivors may attempt to claim compensation through the VA following the death of a loved one. While those funds can prove extremely helpful to the victim’s family, if the victim did not survive for a full 168 hours after the incident, the family may not have the right to pursue compensation through TSGLI.

However, the family may have the right to pursue compensation through the service member’s life insurance policy, which may alleviate some financial strain during the difficult period following the loss of a loved one.

Your injury did not occur because of medical treatment or a physical or mental illness.

For example, if diabetes leads to poor circulation and wound healing that ultimately results in amputation, you would not have the right to claim compensation through TSGLI. On the other hand, if your amputation occurs because of a traumatic injury, including a motorcycle accident, boating accident, or climbing accident, you may have the right to pursue compensation for your injuries.

You did not use illegal drugs or commit a felony at the time the injury occurred.

If you committed a felony or used illegal drugs at the time of the incident, which could show impaired judgment, you may not have the right to claim compensation through TSGLI.

Your injuries did not occur from a deliberate intent to injure yourself.

Some service members have, in the past, suffered from self-inflicted injuries to get out of the military, return home from deployment, or seek compensation. If the VA shows that you caused your injuries deliberately, whether to harm yourself on purpose or due to a failed suicide attempt, TSGLI coverage may not apply to your injuries.

As a Service Member, What Should I Do if I Suffer Traumatic Injury?

Any time you suffer traumatic injury as a service member, you may need to take steps to protect yourself.

Always seek medical attention.

Serious injuries, including those that likely qualify you for TSGLI benefits, usually require immediate medical attention. If you sustained traumatic injuries, whether on the job or off, seek immediate medical attention for those injuries. In some cases, medical attention can prevent you from permanently losing the use of a limb or sense: for example, immediate treatment following chemical exposure can help you avoid losing your vision. If you fail to seek medical attention, it could worsen your injuries.

Report the injury.

You will need to let your command know about the injury, especially if you remain on active duty. You may continue to receive support, including military-sponsored medical care, during your recovery.

You should offer an honest assessment of how your injuries took place. Integrity remains a vital part of serving in the Armed Forces, and offering a clear and accurate assessment of what caused your injuries can make it easier to determine what compensation you may deserve.

Talk to a lawyer to learn more about your rights.

Any time you suffer serious injuries and need to seek compensation through an insurance policy, program, or personal injury claim, an attorney can help you learn more about your rights.

In the case of a TSGLI claim, a lawyer can help you take a look at the extent of your injuries and the losses you have faced, how they fit into the schedule assigned by the VA, and what compensation you should expect for those injuries. TSGLI claims clearly lay out the compensation each victim should recover.

However, in some cases, the VA may deny the vital compensation you both need and deserve for your injuries. An attorney can help you understand your rights, make sure all paperwork gets filed correctly, and fight for you, if needed, as you manage your claim.

An attorney may also provide you with more information about other types of compensation you may deserve due to your injuries, including whether you may have grounds for a personal injury claim.

Why Might the VA Deny My Claim?

In general, the VA may offer several reasons for claim denial.

You failed to fill out the paperwork correctly.

Seeking TSGLI benefits, like many military processes, requires correctly filling out a great deal of paperwork before you can receive the compensation you deserve. A lawyer can help go over your paperwork, make sure you have not missed any important details, and ensure that it contains all the information needed to increase the odds that you will recover the benefits you deserve.

Your claim does not meet TSGLI eligibility standards.

While TSGLI does cover injuries sustained outside the line of duty, that does not necessarily mean that the VA will automatically pay out those benefits for any injury you suffer. If your claim does not meet TSGLI eligibility standards, the VA may deny your claim. However, a lawyer can look over your claim and make sure that it genuinely does not fit those standards.

You do not have enough medical information to support your claim.

Sometimes, your claim may simply not include enough medical information to support your claim of disability. In general, you must meet at least two ADLs, or activities of daily living, that you can no longer perform because of your injuries.

Furthermore, your claim must show that your injuries genuinely prevent you from performing those activities. An attorney can help you put together the medical information needed to prove the losses you have faced due to your injuries.

What Should I Do if the VA Denies My Claim?

When you receive a claim denial for TSGLI insurance benefits, you should receive a denial letter, which will tell you why the VA denied your claim and your potential next steps. You should:

Determine your eligibility for appeal.

Sometimes, your letter will let you know that you have the right to appeal the decision that denied your benefits. If it indicates that you do not have the right to appeal the claim, the military may deny any further communications regarding your claim.

Talk to an attorney as soon as possible.

Although TSGLI offers significant financial protection and should kick in automatically for any service member who has SGLI coverage, the VA continues to deny a high percentage of claims related to traumatic injuries each year. An attorney can help you determine why the VA may have denied your claim and what steps you need to take next.

In some cases, claim denial may occur because of forms that you failed to fill out properly or incomplete information on your claim. Addressing those issues promptly can help your appeal go through successfully. An attorney can also help you download and fill out the TSGLI Appeal Request Form (SGLV-8600A).

Was Your TSGLI Claim Denied? Do You Need Help Filing Your Claim?

If you find yourself dealing with the denial of a TSGLI claim and the struggles that go along with it, or you want to make sure that you can maximize the compensation you can recover for your injuries, do not try to handle your claim on your own.

Instead, work with an experienced TSGLI lawyer who can help you seek the compensation you deserve for your injuries during military service. Contact Lucas & Magazine today at (727) 849-5353 or through our contact page for a free consultation.