TSGLI Claim Attorney – How to Get Your Benefits

TSGLI (also known as Servicemembers’ Group Life Insurance Traumatic Injury Protection) is a type of insurance coverage that compensates military service members who suffer certain traumatic injuries while serving in the military. TSGLI payments can range from $25,000 to $100,000 depending on the nature of the traumatic injury. The coverage applies no matter if a service member was injured on-duty or off-duty.

The traumatic injury protection program/TSGLI program is supervised by the U.S. Department of Veterans Affairs (“VA”) and is administered by the Prudential Insurance Company of America.

The traumatic injury that triggers TSGLI coverage is often referred to as a “scheduled loss.” Examples of scheduled losses/injuries that will lead to TSGLI compensation include:

• loss of hearing or loss of speech,
• paralysis,
• amputations,
• traumatic brain injury (TBI), and
• limb salvage.

TSGLI is retroactive so that it covers qualifying injuries incurred after October 7, 2001. A service member can receive benefits if he/she suffered a traumatic injury after this date and was covered by Servicemembers’ Group Life Insurance (SGLI).

If a person files a TSGLI claim and it gets denied, the service member can appeal the denial. A service member who gets denied TSGLI payments will receive a denial letter from his/her branch of service. The letter will set forth the specific instructions on how the member can file the appeal.

A skilled personal injury attorney can help a service member appeal a TSGLI claim denial. An attorney can also help a member or veteran:

• gather medical evidence to support a TSGLI claim,
• request medical records that form the basis of a TSGLI claim,
• manage their ongoing medical care, and
• complete his/her TSGLI application.

Our personal injury lawyers will highlight the following in this article:

• 1. What is a TSGLI claim and who is eligible to file one?
• 2. What is a scheduled loss for TSGLI?
• 3. How much do injured service members receive?
• 4. Is TSGLI retroactive so that it covers past injuries?
• 5. How long does it take to process a TSGLI claim?
• 6. Can a service member file an appeal if TSGLI coverage is denied?
• 7. How can an attorney help an injured military service member?
• 8. Is a TSGLI claim the same as a disability claim?

1. What is a TSGLI claim and who is eligible to file one?

TSGLI is short for “Servicemembers’ Group Life Insurance Traumatic Injury Protection.” TSGLI is a type of insurance protection that compensates armed forces members if they suffered a traumatic event or severe injury while serving in the military.

Eligibility for TSGLI benefits requires that a qualifying service member experiences a traumatic injury, and the service member:

• suffered a scheduled loss that is a direct result of the traumatic injury,
• suffered the traumatic injury before midnight on the day that he/she left the military,
• suffered a scheduled loss within two years of the traumatic injury,
• survived for a period of not less than seven full days from the date of the traumatic event, and
• was an active-duty military member, a Reservist, a National Guard member, on funeral-honors duty, or on one-day muster duty.¹

Note that a service member can qualify for TSGLI benefit payments no matter where an injury occurred and regardless of whether the member was injured on or off duty.²

Note, too, that traumatic injury coverage is not provided if a traumatic injury:

• was self-inflicted,
• involved the use of an illegal drug or a controlled substance that was given or taken without the advice of a medical professional,
• was the direct result of medical or surgical treatment,
• occurred while the service member committed or attempted to commit a felony,
• was the result of a physical or mental illness or disease.³

Qualifying service members and active-duty members must file a claim to receive TSGLI benefits. To file a claim, members have to complete a form SGLV 8600. People can download the application for TSGLI benefits here.

Service members submit a completed application to their branch of service or a regional TSGLI office. Members should also submit additional information in the form of supporting medical documentation (that relates to the injury claimed). Examples of such documentation include:

• occupational/physical therapy reports,
• patient discharge summaries,
• operative reports,
• medical summaries and/or histories, and
• accident reports.

2. What is a scheduled loss for TSGLI?

Not all traumatic injuries will result in a service member receiving a TSGLI benefit.

Traumatic injuries that do qualify for TSGLI compensation are often referred to as “scheduled losses.” This is because the VA has published a two-part document that sets forth specific losses/injuries that qualify for traumatic injury protection. The document is known as the “TSGLI Schedule of Losses.”

According to Part A of the document, examples of qualifying losses/injuries that result in TSGLI payments include:

• certain burns,
• hospitalization due to traumatic brain injury,
• facial reconstruction,
• limb salvage,
• paraplegia (or complete paralysis of both lower limbs),
• quadriplegia (or complete paralysis of all four limbs),
• uniplegia (or complete paralysis of one limb),
• coma as a result of a traumatic injury, and
• genitourinary losses (or losses affecting the penis, testicles, vagina, or ovaries).⁴

Part B of the VA’s “Schedule of Losses” states that a service member may also qualify for TSGLI payments if he/she:

1. suffers a traumatic injury that results in the inability to perform at least two activities of daily living (ADL), or
2. requires hospitalization for 15 consecutive days due to a traumatic injury.⁵

3. How much do injured service members receive?

The specific amount of TSGLI benefits that a service member can receive range from a payment of $25,000 to a payment of $100,000, depending on the specific injury that the service member suffers.⁶

For example, a service member will receive:

• $25,000 for hearing loss in one ear,
• $50,000 for the amputation of a hand,
• $75,000 if an injury requires reconstruction of a victim’s jaw, and/or
• $25,000 if an ADL loss.

TSGLI payments are one-time lump sum payments. They are designed to provide injury victims with short-term monetary support to help them recover from their traumatic events.

4. Is TSGLI retroactive so that it covers past injuries?

Yes. A service member can qualify for retroactive TSGLI benefits if he/she:

1. was injured after October 7, 2001, and
2. is otherwise qualified to receive TSGLI benefits (see Section 1 above).⁷

Any injuries incurred prior to October 7, 2001, do not qualify for traumatic injury payments.

5. How long does it take to process a TSGLI claim?

It takes approximately 120 business days to process a TSGLI claim. This provides that a claimant submits a fully completed claim and all necessary supporting documentation.⁸

Processing times will increase if a service member has to correct a submitted application or must submit additional supporting records/documents.

6. Can a service member file an appeal if TSGLI coverage is denied?

Yes. If a person files a TSGLI claim and it gets denied, the service member can appeal the denial or ask for reconsideration.

A service member who gets denied TSGLI payments will receive a denial letter from his/her branch of service. The letter will set forth instructions on how to file an appeal and how to complete the applicable TSGLI appeal request from.⁹

Potential TSGLI beneficiaries must submit a completed appeals form and any new evidence that they may have regarding their traumatic injury.

In general, claimants have to appeal their claim denials within one year from the date on their denial letters.¹⁰

Members can send their appeal documents to their branch of service via mail, fax, or email. A member’s branch of service, or its higher appeal authority, will make the ultimate decision on any and all appellate issues.¹¹

7. How can an attorney help an injured military service member?

A veteran’s attorney can play a critical role in the TSGLI claim process.

A lawyer can assist service members in:

• gathering medical evidence and records to support a TSGLI claim,
• requesting certain medical records from health care providers,
• completing an TSGLI application, and
• appealing a TSGLI claim denial.

Note that most injury attorneys provide free consultations. A free consultation means that a service member can get legal advice regarding a TSGLI claim without spending a dime.

Further, the communications between an attorney and his/her client are protected by the attorney-client relationship. This means a lawyer cannot disclose a client’s information without first getting the client’s permission.

8. Is a TSGLI claim the same as a disability claim?

No. A TSGLI claim is a separate and different claim from a disability claim.

An injured veteran or service member files a disability claim with the VA in order to receive disability benefits.

VA disability benefits come in the form of tax-free monthly payments. The payments are given to vets who have suffered an injury, or incurred a disease, while on active duty.

Monthly payments can range from $144.14/month to $3,146.42/month depending on the nature and severity of a service member’s injury.

Some common disabilities and medical conditions that qualify for disability compensation include:

• head and back injuries,
• heart disease,
• bone fractures,
• cancer,
• arthritis,
• sleep disorder,
• anxiety and depression,
• post-traumatic stress disorder (PTSD), and
• Gulf War illness.

Note that if a service member suffers a traumatic injury that qualifies for TSGLI benefits, the member may also be entitled to receive disability benefits. If the person qualifies for such, he/she would receive a one-time lump sum payment for the TSGLI claim and then a payment every month for the disability claim.

A VA disability claims attorney can help a veteran or service member:

• gather the important evidence to support a disability claim,
• work a claim up and submit the application for benefits, and
• appeal a disability claim denial.

For additional help…

We support all of the brave service members and veterans across the U.S. If you have suffered a traumatic injury while in the military, you should consult with an experienced personal injury lawyer or a veteran’s attorney for help.

A skilled lawyer can help you gather the important evidence to support a TSGLI claim, can assist in working your claim up, and will prove invaluable services in appealing a claim denial.

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