TSGLI

TSGLI, or Servicemembers’ Group Life Insurance Injury Protection Program, offers automatic coverage in case of traumatic injury and is available to all servicemembers who have SGLI (Servicemembers’ Group Life Insurance). TSGLI is different from SGLI in that it is not really a life insurance contract. It is an injury protection program, so it will pay benefits to servicemembers who are severely injured/have traumatic injuries. While SGLI pays benefits to beneficiaries after insured servicemembers’ death, TSGLI provides financial assistance to servicemembers themselves after they sustained traumatic injury on or off duty.

Those who qualify for automatic SGLI coverage also qualify for automatic TSGLI coverage. TSGLI is available to active duty members, reservists, National Guard members, funeral honors duty and one-day muster duty and offers a one-time payment. In some respect TSGLI is similar to an accelerated death benefit protection on a regular life insurance policy. It pays benefits for traumatic injuries to servicemembers during their lives.

 What is the Amount of TSGLI?

The amount of TSGLI depends on the type of traumatic injury and varies from case to case. It is not an income-replacing tool, but rather a supplemental support payment for those who suffered traumatic injury and need time to recover. In difficult times when a servicemember is injured, TSGLI payments are very helpful. However, if a TSGLI claim is denied, it may put a great deal of pressure on an injured servicemember.

Why Are TSGLI Claims Get Denied?

Many TSGLI claims get denied due to eligibility issues. First, to be covered under TSGLI, a servicemember must have valid SGLI coverage. If SGLI coverage was not in force at the time of the traumatic injury, a TSGLI claim will be denied. Please read our SGLI page to know what requirements the program places on servicemembers. However, even if you had no SGLI coverage and incurred a severe loss as a result of traumatic injuries between October 7, 2001 and November 30, 2005, you may still qualify for TSGLI protection. If a TSGLI claim is denied because of underlying issues with SGLI coverage, our SGLI attorney can help you appeal the denial of your TSGLI claim.

Second, in order to be eligible for TSGLI, the insured’s injury must fall into one or more of the following categories1:

Loss of Sight

Loss of Hearing

Loss of Speech

Quadriplegia

Hemiplegia

Paraplegia

Uniplegia

Burns

Amputation of Hand

Amputation of 4 Fingers on 1 Hand or Thumb Alone

Amputation of Foot

Amputation of All Toes Including the Big Toe on 1 Foot

Amputation of Big Toe Only, or Other 4 Toes on 1 Foot

Limb Salvage of Arm

Limb Salvage of Leg

Facial Reconstruction (Jaw, Nose, Lips, Eyes, Facial Tissue)

Coma from Traumatic Injury and/or Traumatic Brain Injury (TBI) Resulting in Inability to Perform at Least 2 Activities of Daily Living (ADL)

Hospitalization Due to Traumatic Brain Injury

Genitourinary Losses (Anatomical Loss of the Penis, Permanent Loss of Use of the Penis, Anatomical Loss of One Testicle, Anatomical Loss of Both Testicles, Permanent Loss of Use of Both Testicles, Anatomical loss of the vulva, uterus, or vaginal canal, Anatomical loss of one ovary, Anatomical loss of both ovaries, Permanent loss of use of both ovaries, Total and permanent loss of urinary system function)

Traumatic injury resulting in inability to perform at least 2 Activities of Daily Living (ADL)

Hospitalization due to traumatic injury

Each of the above traumatic injury categories has its own eligibility requirements. If your medical records classify your injury as one falling into one of the above categories, it does not automatically mean that your TSGLI claim will be approved. Likewise, if your medical records show traumatic injury but it is not described as one of the above classifications, your claim may still be approved. A TSGLI attorney at our law firm will help guide you through the process of getting your TSGLI paid.

When Did TSGLI Protection Become Effective?

The TSGLI law became effective on December 1, 2005. However, Congress directed that TSGLI apply retroactively to October 7, 2001 for members who incur a qualifying loss as a direct result of injuries incurred on or after October 2001, through and including November 30, 2005 regardless of where the injury occurred, and regardless of whether they had SGLI coverage.

After December 1, 2005, all servicemembers who are covered by SGLI are eligible for TSGLI coverage, regardless of where their qualifying traumatic injury occurred. This does not guarantee automatic TSGLI claim approval. Every claim needs to be completed by a healthcare provider and must be filed with documentation that supports the healthcare provider’s evaluation of the servicemember’s injuries.

Does TSGLI Policy Have Exclusions?

As any other life insurance contract, TSGLI has several exceptions from coverage. Thus, a TSGLI claim is likely to be denied if the injury is the result of:

an intentionally self-inflicted injury or an attempt to inflict such injury;

use of an illegal or controlled substance that was not administered or consumed on the advice of a medical doctor;

the medical or surgical treatment of an illness or disease;

a traumatic injury sustained while committing or attempting to commit a felony;

a physical or mental illness or disease (not including illness or disease caused by a wound infection, a chemical, biological, or radiological weapon, or the accidental ingestion of a contaminated substance).

If your TSGLI claim has been denied due to one of these exclusions, call our TSGLI attorneys for a free consultation. You may appeal the denial of your claim and have the denial reversed. Of course, some claims are properly denied, but there are many wrongfully denied claims and you may want to speak with a TSHLI lawyer before accepting the denial.

When Should a Scheduled Loss Occur in Order to Receive TSGLI Benefits?

Your loss should occur within two (2) years of the date of your injury in order for your TSGLI claim to be approved. For example, if the insured sustained a loss of sight 3 years after he received a traumatic injury, the claim may be denied. However, there are certain exceptions to this rule and it is best to consult with an experienced TSGL attorney who will explain you your rights.