Are Any Injuries Excluded From TSGLI?

Published On: December 13, 2021

TSGLI is a form of insurance that covers service members who suffered a traumatic injury while in service, whether the injury occurred when in line of duty or off duty. Congress created the insurance benefits program in 2005, aiming to assist servicemembers with serious traumatic and brain injuries.

In conjunction with the DOD, the Department of Veterans Affairs administers the program, while the various service branches determine the eligible service members. Despite the considerable percentage of the service members who enjoy the benefits, many deserving service members face challenges.

For instance, although it is a rider to the Servicemember Group Life Insurance (SGLI), many service members don’t know about it. Second, most members’ eligibility criteria for traumatic brain injury are subjective and unclear. Third, many service members have difficulty accessing their medical records to prove their eligibility.

If you paid your SGLI contribution when you were in service, then you are eligible for compensation amounting to up to $100,000 if you suffered a significant injury.

While TSGLI covers anyone who experienced a traumatic injury on or after October 7, 2001, there are specific qualifications that one must meet.

  • Must have been an active member of the military, national guard, reservist, 1-day muster duty, or on-funeral honors duty.
  • Must have suffered loss as a direct result of the traumatic injury.
  • Suffered traumatic injury before the midnight of the day you left the military.
  • Must have survived seven full days or more after the injury.
  • Experienced a scheduled loss within two years of the traumatic injury.

If you pass the above qualifications, you might require a TSGLI appeal lawyer to help you appeal and claim your deserved benefits. The right lawyer works with you to help you understand the benefits and works with you to ensure you get substantial compensation if you are eligible. Contact Lucas & Magazine today to get started.

Injuries Covered by TSGLI

TSGLI covers a wide range of injuries, including loss of limbs and loss of function.

According to the information found on the U.S Army official website, My Army Benefits, you must have suffered a “scheduled loss” among any of these injuries to qualify for the benefits:

  • Brain damage
  • Disfigurement
  • Amputation
  • Paralysis
  • Loss of sight
  • Loss of hearing
  • Severe burns
  • Facial reconstruction
  • Loss of speech
  • Traumatic injury requiring hospitalization of 15 consecutive days

If you suffer any of the above, you should contact an attorney to help you with the investigation where needed and claim your benefits.

Before October 2010, TSGLI covered only those injured in Operation Enduring Freedom in Afghanistan and Iraq.

However, when President Barack Obama signed the Veterans’ Benefits Improvement Act of 2010, the benefits available to servicemembers under the SGLI expanded. With the change, people injured between October 7, 2001, and Nov. 2005 could now receive the benefits even if not covered by the SGLI.

TSGLI Exceptions

Despite the changes, the coverage exempts these injuries:

  • Self-inflicted injuries or those that occur when trying to injure yourself.
  • Injuries that happen when committing or attempting to commit a felony.
  • Drug or substance abuse-related injuries when using illegal or controlled substances taken in a manner inconsistent with the doctor’s instructions.
  • Injuries resulting from medical or surgical treatment of a disease.
  • Resulting from mental or physical illness. However, this excludes diseases or conditions caused by accidental consumption of a toxic substance or wound infection by a biological, radioactive, or chemical weapon.

In addition, the TSGLI does not cover spouses and children even if the Family SGLI (FSGLI) covers them, service members not covered by SGLI coverage, and veterans insured under the Veterans’ Group Life Insurance (VGLI).

How to Claim Your TSGLI Benefits

If you qualify for TSGLI benefits, you, your power of attorney, trustee, or guardian, need to fill in the required SGLV 8600 Application for the TSGLI Benefit form. The form contains a part B that a healthcare provider must complete and includes the injury information that qualifies you for the benefit. In addition, you need to provide medical documentation of your injuries and how they occurred.

Some documentation that can support your claim include:

  • Hearing tests for hearing loss
  • Speech test for speech loss
  • Eye tests for sight loss
  • Occupational/physical therapy results
  • OR report in case of amputation
  • Medical/physical evaluation board
  • Neurological reports
  • Other diagnostic test results
  • Documents demonstrating the type of injury and duration of Activities of Daily Living loss (ADL)
  • Accident report
  • Line of duty
  • Radiographic reports
  • Patient movement request
  • Patient discharge summaries

You may file only one TSGLI report regardless of the number of traumatic injuries experienced. However, you need to include all the injuries encountered due to that event.

Each army branch service processes its member’s TSGLI claims, with the processing and adjudication taking approximately 120 days from the day they receive the application. However, some factors such as missing medical documentation and incorrect or missing contact information can prolong the processing of your application.

After the army decides on your claim, they forward it to the Office of the Servicemembers Group Life Insurance (OSGLI) for review. It takes OSGLI about 14 working days to complete processing your claim.

You will receive a monetary deposit in the account specified in the TSGLI form if it is approved. If your claim is denied, the TSGLI or the OSGLI will send you a letter advising you to file an initial appeal, also known as reconsideration.

Activities of Daily Living (ADL)

Loss of ADLs is one of the major reasons many service members seek TSGLI benefits. You are considered eligible for these benefits if you cannot perform at least two of the six ADLs without assistance for at least 30 consecutive days. But for you to receive the benefits, a medical professional must certify your ADL loss.

The six ADLs include:

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

Payment benefits increase by $25,000 as follows, depending on the number of consecutive days you have lost your ADLs.

  • $25,000 for 30 consecutive days of ADL loss
  • $50,000 for 60 straight days of ADL loss
  • $75,000 for 90 consecutive days of ADL loss
  • $100,000 for 120 straight days of ADL loss

Since your TSGLI benefits provide financial relief to help you get through the traumatic injury aftermath, the insurance makes your benefit payments in a lump sum. However, if you experienced more than one traumatic injury, or if your injuries progress from one qualifying injury to a severe one, then you would receive more than one payment.

What to Do After a TSGLI Claim Denial

Several factors can lead to TSGLI claim denial, including:

  • Wrong paperwork
  • Failing to meet the requirements
  • Not being registered with SGLI
  • An error by the person tasked with approving your claim
  • Confusion about the start date of the program and whether the injury occurred when the TSGLI was in effect
  • Failure to classify the damage the right way or incorrect medical description

Regardless of why TSGLI denies your claim, the experience of having to live with the pain daily is painful. If your claim gets rejected, it is wise to work with an attorney who can help fight for your claim using the right legal and medical resources.

The Law Offices of Lucas & Magazine can help you prove the injury by obtaining the required documentation, which may be hard for you to collect in your injured condition. In most cases, the necessary medical records from field hospitals are usually incomplete or missing. However, the most challenging part is looking for witnesses for the traumatic event, especially if the witness service member has long been deceased.

A team of dedicated attorneys helps to ensure that all your records are complete and provide a detailed explanation of your injuries and the harm caused. If you require additional medical records, your attorney can help you obtain them through qualified medical professionals. By working with the Law Offices of Lucas & Magazine, you have the confidence that you are not alone in the journey to making your claim with the TSGLI.

In addition to helping you file and obtain the required documents, your lawyer will answer any questions you may have and offer guidance in case of claim denial. Regardless of the reason for rejection, our team of lawyers will help you sort through the reasoning and provide the required assistance. Be sure to contact us for any TSGLI claim denial consultation.

Frequently Asked Questions

How Long Does It Take to Process TSGLI?

How long it takes to process your TSGLI claim depends on whether it is an initial claim or an appeal. If you fill in the benefits claim form correctly and attach all the necessary documents, the processing time for your TSGLI claim can take anything from 90 days. If you miss some documents or have inaccuracies in the application, processing can take one year.

How Long Do I Have to File a TSGLI Claim?

There is no statute of limitations for filing a TSGLI claim. You can claim for traumatic injury benefit as long as you received the injuries after Oct. 7, 2001. In addition, you can file for an IED bomb injury lawsuit if you were injured via an IED.

Am I Eligible for TSGLI?

You are eligible for the TSGLI benefits if you are an Armed Forces member and have suffered severe injuries. This is whether the injuries occurred when on or off duty or on active service or reserve. If you are a Servicemembers Group Life Insurance member, you automatically qualify for the TSGLI. However, you must meet the requirements discussed above.

How Can I Ensure My Claim Is Not Rejected?

While there are no guarantees that your claim will automatically be accepted, you can minimize rejection risks by filling your application form legibly. Ensure that your contact and bank information are correct, have the required signatures for medical release, power of attorney, and attach the necessary supporting documents. A VA accredited attorney can do all of this for you and more.

Can I Get TSGLI for PTSD?

While TSGLI does not cover PTSD, the current TSGLI policy manual updated on October 4, 2013, PTSD might qualify you for benefits. However, one must be hospitalized for at least 15 days under the assessment of PTSD and traumatic brain injury (TBI).

How Do I File for an Appeal If My Claim Is Rejected?

If TSGLI rejects your claim, they will send you a notification in the mail advising you on whether you should file for a formal Request Appeal Form or not. They will also specify how much time you have to file for an appeal.

You’re better off letting an accredited lawyer file an appeal for you.

Will I Be Compensated if I Have More Than One Traumatic Injury?

You can submit a separate claim for any events occurring at least seven days apart.

How Do I Check My TSGLI Claim Status?

It is possible to check your TSGLI status by visiting the TSGLI website, filling in your information, and following these steps:

  • Enter your policy number on the form
  • Select your claim of policy
  • Enter the financial year
  • Enter the generated number that displays on the screen
  • Click view

How Do I Get the TSGLI B Bond?

To download your TSGLI B Bond, visit the TSGLI official website and:

  • Enter your policy number
  • Choose the right suffix
  • Then click on the “Get Policy Bond” button
  • Wait for the file to download but do not click the enter button.

How an Attorney Can Help You Claim Your TSGLI Benefits

After experiencing traumatic injuries during military service, you could obtain $100,000 tax-free benefits through TSGLI. The traumatic injury protection program offers benefits even if your injuries occurred outside the line of service. However, obtaining the benefits is not a straightforward process as you are likely to get turned down or receive settlements that are far lower than the injuries experienced.

VA-accredited attorneys understand TSGLI claims and appeals and can gladly help you claim the benefits you deserve.

If you were unfairly denied TSGLI benefits or have difficulty gathering the required supporting documents contact a VA-accredited TSGLI attorney today to discuss your case and decide on the way forward.