Servicemember Traumatic Injury Insurance Claims

TSGLI (also known as Servicemembers’ Group Life Insurance Traumatic Injury Protection) provides short-term financial support to help eligible service members recover from a severe injury. If you were covered by TSGLI and experienced a traumatic injury while serving in the military, find out how to file a claim for TSGLI or appeal a past decision.

 

Am I eligible for TSGLI?

You may be eligible for TSGLI compensation if you were insured by TSGLI and experienced a traumatic injury on or after October 7, 2001, and you meet all of the requirements listed below.

All of these must be true. You:

  1. Have a scheduled loss that is a direct result of the traumatic injury, and
  2. Suffered the traumatic injury before midnight on the day that you left the military, and
  3. Suffered a scheduled loss within 2 years (730 days) of the traumatic injury, and
  4. Were an active-duty military member, a Reservist, a National Guard member, on funeral-honors duty, or on 1-day muster duty.
 

Does TSGLI cover injuries that occur off duty?

Yes, TSGLI may cover injuries that occur on duty or off duty.

 

Are any injuries excluded from TSGLI?

Yes. To qualify for TSGLI, none of the descriptions below can be true of your injury.

None of these can be true.  Your injury can’t: 

  1. Be self-inflicted on purpose or the result of an attempt at self-injury, or
  2. Involve the use of an illegal drug or a controlled substance that was given or taken without the advice of a medical doctor, or
  3. Be the result medical or surgical treatment of an illness or disease, or
  4. Occur while you’re committing or trying to commit a felony, or
  5. Be the result of a physical or mental illness or disease (not including illness or disease caused by a wound infection; a chemical, biological, or radiological weapon; or accidentally swallowing a contaminated substance)
 

Can I get TSGLI compensation for a past injury?

You may be able to get retroactive TSGLI (meaning that it takes effect starting from a date in the past) if you were injured on or after October 7, 2001, and you meet all of the TSGLI qualifications listed above.

 

What types of injuries are covered by TSGLI?

  1. Amputation of 4 Fingers on 1 Hand or Thumb Alone
  2. Amputation of All Toes, Including the Big Toe on 1 Foot
  3. Amputation of Big Toe Only, or other 4 Toes on 1 Foot
  4. Amputation of Hand
  5. Burns
  6. Coma from Traumatic Injury and/or Traumatic Brain Injury (TBI). TBI resulting in the inability to Perform at Least 2 Activities of Daily Living (ADL)
  7. Facial Reconstruction (Jaw, Nose, Lips, Eyes, Facial Tissue)
  8. Foot Amputation
  9. Hearing Loss
  10. Hospitalization due to Traumatic Brain Injury
  11. Injuries to Men – Anatomical Loss of Penis, Permanent Loss of Use of Penis, Anatomical Loss of One Testicle, Anatomical Loss of Both Testicles. Additionally, permanent Loss of Use of Both Testicles, permanent loss of urinary system function
  12. Injuries to Women: Anatomical Loss of uterus, vulva, or vaginal canal, anatomical loss of one ovary. Additionally, anatomical loss of both ovaries, permanent loss of use of both ovaries, total and permanent loss of urinary system function
  13. Limb Salvage of Arm
  14. Limb Salvage of Leg
  15. Loss of Speech
  16. Loss of Vision
  17. Paraplegia
  18. Quadriplegia
  19. Uniplegia
 

Are there other types of claims that also apply?

Yes – Service members can file a claim related to the Loss of Activities of Daily Living (ADLs).  A service member is considered eligible if the member is unable to independently perform at least 2 of 6 ADLs listed below.  The inability must last at least 30 consecutive days.  Generally speaking, inability means that the service member requires assistance to safely perform the activity as a result of the injury.

What are the six (6) ADLs?

  1. Bathing
  2. Continence
  3. Dressing
  4. Eating
  5. Toileting
  6. Transferring
 

Who’s covered by TSGLI?

Service members who were covered by TSGLI at the time of the injury including:

  1. Active duty
  2. Funeral Honors Duty
  3. National Guard
  4. One-Day Muster Duty
  5. Reserve
 

What kind of benefits can I get through TSGLI?

You may get $25,000 to $100,000 in short-term financial support to help in your recovery from a traumatic injury.

 

Does your firm handle TSGLI appeals on a contingency basis?

Yes.  There we charge no fee or costs until you recover.

 

How do I get these benefits?

You were automatically covered through TSGLI if you were signed up for full-time SGLI at the time of your injury. This insurance covers you even if your injury happened while you were off duty.

 

Still wondering what qualifies as a TSGLI claim?

Below are nine examples of cases which would qualify for TSGLI compensation, followed by two examples of cases which would not qualify. To determine if you have a TSGLI claim contact us today at (800) 277-1193. It won’t cost you anything unless we are successful in obtaining compensation for you.

Covered by TSGLI:

Example 1: Surgical treatment of a traumatic injury covered by TSGLI: A member’s vertebra is fractured in a mortar blast in Iraq. While undergoing surgery for the fractured vertebrae, a blood clot forms during the surgery on the member’s back, causing the member to be paralyzed from the waist down. The member’s loss is covered by TSGLI.

Example 2: A member is injured in a car accident. She suffers injuries to her leg. Unfortunately, her wounds develop a pus-forming infection (pyogenic infection) and spread gangrene up her leg resulting in the loss of her leg. The member’s loss would be covered by TSGLI.

Example 3: A member is hit with the materials from a chemical weapon. He develops an illness that causes the deterioration of his retinas resulting in the permanent loss of his vision. The member’s loss would be covered by TSGLI.

Example 4: A member is accidentally exposed to radiation while working at an Army weapons depot. The member subsequently develops cancer and has to have his leg amputated. The members’ loss would be covered by TSGLI.

Example 5: A member serving in Iraq is involved in a skirmish with enemy forces. He is forced to wait out the enemy for three days in a remote area. He only has a one-day supply of water. In order to survive, he drinks water from a small stream nearby. After escaping from his hiding place, the member returns to his base and becomes ill with vomiting, diarrhea, and a fever. After a number of days with these symptoms, the member falls into a coma for 20 days. It is determined that the illness causing the coma was a result of drinking contaminated water from the stream. The member’s loss would be covered by TSGLI.

Example 6: A member is injured when his motorcycle slides on a wet road. He has deep skin abrasions, termed road rash, on his arms and legs. He undergoes wound care at a local Burn Center. He is unable to perform bathing and dressing for 30 days after his accident. The member does not qualify for payment under burns but does qualify for $25,000 for the inability to perform two ADLs for 30 days.

Example 7: A member goes into a coma as the result of a military motor vehicle accident. The member recovers from the coma 60 days later. The member’s loss would be covered by TSGLI.

Example 8: A member is injured in an automobile accident on March 1. The member is taken to a local hospital trauma center and is admitted to the hospital. On March 6, the member’s condition is stabilized and the member is transferred to another hospital. The member is released from the second hospital on March 17. The member has accrued 15 consecutive hospitalization days (March 1-15) and is paid a $25,000 TSGLI benefit.

Example 9: A member is injured in a car accident on March 1. He is hospitalized from March 1 to March 12 but due to his injuries he is unable to perform the ADL of bathing and dressing for 30 days from March 1 to March 30. He regains his ADL on March 31. However, due to complications, he is hospitalized a month later from May 1 to May 15. The member will receive a $25,000 benefit for loss of ADL due to OTI for 30 days. He will not be paid for the subsequent 15- day hospitalization. Payment is made for either the 15-day hospitalization OR the first ADL milestone, whichever occurs first, not both.

Not Covered by TSGLI:

Example 1: Diagnosis of an illness or disease that is not covered by TSGLI: A member goes to the hospital for a routine colonoscopy. Due to medical error, the patient is injured and must remain in the hospital for 15 days. The member’s loss is not covered by TSGLI.

Example 2: Medical or surgical treatment for an illness or disease that is not covered by TSGLI: A member has diabetes and her condition begins to cause problems to her leg resulting in the amputation of her leg. The member’s loss is not covered by TSGLI because it was the result of treatment for an existing condition.

 

Contact Us

To contact us for a free confidential consult, you can call us at (850) 435-7000 or (800) 277-1193. You also can request a confidential consultation by clicking Free & Confidential Consult, which form will be immediately reviewed by one of our attorneys.