TSGLI Appeal Lawyer
At Brett O’Brien Law, LLC, our TSGLI appeal lawyers are highly knowledgeable of the TSGLI claim and appeal process and will aggressively pursue the benefits that you deserve. Moreover, our TSGLI appeal lawyers handle TSGLI claims and appeals nationwide.
Whether you are an active duty member, a reservist, or a National Guard member, you may be eligible for substantial TSGLI benefits as a result of any injuries that you have sustained. Moreover, the broad sweeping TSGLI benefits are available to you even if your injury was not sustained while on duty or even related to your military service.
So long as a servicemember who is covered by Servicemembers Group Life Insurance (SGLI) can prove that he or she sustained a covered injury, they may be eligible for a lump sum fee of up to $100,000.00 — regardless of whether the injury occurred on or off duty. For example, if an off-duty servicemember is involved in an auto accident that results in a covered injury, he or she may be eligible for TSGLI benefits, just as if they were injured during combat.
Unfortunately, many injured servicemembers are not even aware that they are eligible for this substantial benefit. Our TSGLI appeal lawyers, however, are committed to making servicemembers aware of this benefit. In addition, we will work hard to ensure that qualified servicemembers receive this benefit and that they receive the highest level of compensation available.
The Department of Veterans Affairs is notorious for denying TSGLI claims that should be covered. As an experienced lawyer and servicemember himself, TSGLI appeal lawyer Brett O’Brien is highly knowledgeable of TSGLI requirements and knows how to present the best possible case on behalf of his clients. Moreover, as we handle TSGLI appeals on a contingency basis, there is no fee until we win your case.
What is TSGLI?
The Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) program was established to provide relief to servicemembers after suffering traumatic injury. TSGLI provides payments to servicemembers who are severely injured – whether on duty or off duty – as a result of a traumatic event. TSGLI payments, which vary based on the loss suffered, range from $25,000.00 to $100,000.00.
Servicemembers who are enrolled in the Servicemembers Group Life Insurance (SGLI) are automatically enrolled in TSGLI. Thus, the TSGLI program provides automatic traumatic injury coverage to servicemembers covered under SGLI. Moreover, it is available to soldiers from all components – Active, Reserve, or National Guard.
Perhaps most importantly, in order to qualify for TSGLI coverage, the injury does not have to be combat related or service connected and it will not affect other Veteran’s Affairs disability claims.
As an example of the broad ranging coverage requirements, an Army Reserve service member who suffered a traumatic injury in a motorcycle accident unrelated to Reserve activity would be able to recover TSGLI benefits.
Who Qualifies for TSGLI?
In order to qualify, each of the following must be true:
The servicemember was insured by SGLI at the time of the injury (servicemembers who did not elect SGLI coverage, however, will be covered if their injury occurred between October 7, 2001, and December 1, 2005);
The servicemember must suffer a “scheduled loss” as a direct result of a “traumatic injury” due to a “traumatic event”;
The servicemember must have suffered the traumatic event before separating from service;
The servicemember must have suffered the scheduled loss within two years of the traumatic event;
The servicemember was an active-duty military member, a Reservist, a National Guard member, on funeral-honors duty, or on 1-day muster duty; and
If deceased, the servicemember must have survived at least 7 full days from the date of the traumatic event.
A.“Scheduled Loss” Defined.
In order to qualify as a “scheduled loss,” the condition must be listed in the TSGLI Schedule of Losses, which lists all covered losses and payment amounts.
Covered loss include, but are not limited to: Loss of speech, hearing, and/or sight; Burns; Paralysis; Amputation; Facial reconstruction; Traumatic brain injuries/comas; Hospitalization due to traumatic injuries; and Limitations on two or more Activities of Daily Living (ADL) for 30 days (ADL include bathing, continence, dressing, eating, toileting, and transferring).
B. “Traumatic Injury” Defined.
“Traumatic injury” means physical damage to the body.
C.“Traumatic Event” Defined.
Under the TSGLI policy, “traumatic event” means the application of external force. “External force” means force or power that causes an individual to meet involuntarily with an object, matter or entity that causes individual harm. This can include: Violence, Chemical, biological or radiological weapons, Accidental ingestion of a contaminated substance and/or Exposure to the elements (causing injuries such as heat stroke or frostbite).
In order to qualify as a traumatic event, the event must involve some sort of physical, external impact upon a person. For example, an airplane crash, a car accident, or a fall would all qualify as a traumatic event. It would not, however, include an injury that was caused by the stress or strain or a normal work effort, such as a back injury due to lifting a ladder.
What Are Activities of Daily Living (ADL)?
Loss of ADLs are the primary losses through which servicemembers seek TSGLI benefits. Servicemembers are considered eligible for TSGLI benefits if they are unable to, without assistance, perform at least two of a total of six ADLs for at least 30 consecutive days. Medical professionals must certify the servicemembers ADL loss.
The 6 ADLs are: (1) bathing; (2) continence; (3) dressing; (4) eating; (5) toileting; and (6) transferring. TSGLI payment increments increase by $25,000.00 depending on the total number of consecutive days of ADL loss as follows: 30 consecutive days of ADL loss: $25,000.00, 60 consecutive days of ADL loss: $50,000.00, 90 consecutive days of ADL loss: $75,000.00, 120 consecutive days of ADL loss: $100,000.00,
Are Any Conditions Excluded?
Certain injuries and conditions are excluded from TSGLI coverage, including: Injuries that occurred while attempting suicide or that were intentionally inflicted; Injuries that were received due to the medical or surgical treatment of an illness, disease, or condition; Injuries that were received while the servicemember was under the influence of a controlled dangerous substance; and/or Injuries that occurred while committing or attempting to commit a felony.
How Are TSGLI Payment Made?
Your TSGLI benefit payments will be made in a lump sum, one-time payment since they intended to provide financial relief to help you get through the immediate aftermath of your injury. More than one payment, however, would be made if there were separate traumatic events giving rise to TSGLI benefits or if the servicemember progresses from one qualifying injury to a greater level of loss (for example, progressing from 30 to 60 to 90 consecutive days of ADL loss).
How to File for TSGLI
To file for TSGLI, you will need to file a claim by filling out the Application for TSGLI Benefits (SGLV 8600) and sending the application via fax, email, or regular mail to the appropriate service branch (addresses are listed on the form).
A healthcare provider must complete Part B of the form, which provides details of the injuries. The servicemember must also provide medical documentation of their injuries as well as an explanation of how they occurred. Additional documentation may include, as applicable: Occupational and/or Physical Therapy Reports (ADL Documentation), Neurological Reports (TBI/ADL Documentation), Operative Reports (amputation), Hearing/Speech/Sight Test Results, Patient Discharge Summaries, Medical Summary and/or History, Patient Movement Request, Accident Report, Line of Duty (LOD), Medical/Physical Evaluation Board (MEB/PEB), Other pertinent documents demonstrating injury type and duration of ADL loss.
For more information about filing for TSGLI, visit the Veterans Affairs TSGLI website.
How Long Will My Claim Take?
Each service branch processes its members’ claims. According to the Army, claims usually take 120 business days to process. Once the service branch makes a decision, the claim will be forwarded to the Office of Servicemembers’ Group Life Insurance (OSGLI) for review. It will then take approximately 14 additional business days to complete the process.
If your claim is approved, the OSGLI will deposit money directly into the account you specified on the application. If your claim is denied, you will receive a letter outlining the appeal process.
If you file for TSGLI, don’t be surprised if you are denied. In fact, the VA routinely denies claims, even when the injury appears to qualify for benefits. The TSGLI appeal lawyers at Brett O’Brien Law, LLC, however, can help you (1) determine where you qualify for TSGLI; and (2) assist you in the initial application process, thus giving you the best chance at receiving the largest benefit possible.
How to Appeal a Denial
If a servicemember feels that their claim has been wrongly denied, they can apply for Reconsideration. If their request for Reconsideration is denied, the servicemember can file an Appeal to the U.S. Army TSGLI Appeal Panel. If their Appeal is denied, servicemembers can seek a further Review before the U.S. Army Review Board Agency. Servicemembers should submit a TSGLI Appeal Request Form (SGLV 8600A) with each submission.
If you have new evidence or documents to support your appeal, you should send those records in with the appeal form. On the appeal form. Be sure to check the box indicating that you are submitting new evidence and describe what your new evidence proves.
If you have new losses to claim, however, you will need to complete a new Application for TSGLI Benefits (SGLV 8600).
Appeals should include the strongest medical documentation you can obtain to prove your claim (which often means including reports from medical professionals) and should set forth the reasons why you disagree with the initial determination.
How Long Do I Have to Appeal?
Your denial letter will set forth how long you have to file your request for reconsideration, appeal, or review. In general, however, you will have one year to submit your request.
How Long Will the Appeal Take?
If your claim is at the final level and is under review by the TSGLI Review Panel, processing time is approximately one year.
TSGLI Appeal Lawyers
The TSGLI appeal lawyers at Brett O’Brien Law, LLC, provide nationwide representation to servicemembers applying for and appealing TSGLI claims. Unfortunately, many servicemembers have found that obtaining TSGLI benefits is not an easy task.
Our TSGLI appeal lawyers can help you with your claim and appeal. In addition to gathering and reviewing your medical records and preparing witness statements, we will prepare a full explanation of your injuries and the harm they have caused you. Moreover, if we believe that you need additional medical examinations or reports in order to prove your claim, we work with qualified and experienced medical professionals to help process your TSGLI claim.
Call us today for an initial consultation. During your consultation, we will review the facts surrounding your injury and discuss your options. If we determine that we can handle your case, we will represent you on a contingent basis, meaning you will not be charged for legal fees or costs unless we obtain compensation.
Call the TSGLI appeal lawyers at Brett O’Brien Law today for a free consultation at (202) 600-4996.
Additional Helpful Resources
TSGLI Procedures Guide – Complete guide created by the VA for administering the TSGLI program
Veterans Affairs TSGLI website – Contains forms and instructions for applying for an appealing TSGLI claims
Application for TSGLI Benefits (SGLV 8600) – Initial TSGLI application form
TSGLI Appeal Request Form (SGLV 8600A) – TSGLI appeal form
Request Pertaining to Military Records (SF-180) – to obtain a copy of the documentation that you previously submitted for your TSGLI claim
TSGLI Schedule of Losses – Lists qualifying injuries with payment amounts