TGSLI Forum

[Combat Eng]

What Are The Eligibility Requirements For Payment Under TSGLI?

To be eligible for payment of TSGLI, you must meet all of the following requirements:

• If injured on or after December 1, 2005, you must be insured by SGLI when you experience a traumatic event. For those injured between October 7, 2001 and November 30, 2005, SGLI coverage is not required to be eligible for TSGLI.
• You must incur a scheduled loss and that loss must be a direct result of a traumatic injury.
• You must have suffered the traumatic injury prior to midnight of the day that you separate from the uniformed services.
• You must suffer a scheduled loss within 2 years (730 days) of the traumatic injury.
• You must survive for a period of not less than seven full days from the date of the traumatic injury. (The 7-day period begins on the date and time of the traumatic injury, as measured by Zulu [Greenwich Meridian] time and ends 168 full hours later).

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Do you have to be in service to apply for a TSGLI benefit?

No. As long as the Servicemember experienced the traumatic event while in service and covered by SGLI, they can apply for the benefit even if they have since been discharged.



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What if the traumatic injury occurred prior to the beginning of the program?



When the original TSGLI law was enacted, Congress directed that TSGLI would be retroactive to October 7, 2001, for members who incur a qualifying loss as a direct result of injuries incurred on or after October 7, 2001, through and including November 30, 2005, in Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF).
However, effectiveOctober 1, 2011, Public Law 111-275 removes the OEF/OIF requirement for injuries incurred during the retroactive period. As a result, TSGLI coverage will be provided retroactively for members who incurred severe losses as a result of traumatic injuries incurred between October 7, 2001 and November 30, 2005, regardless of where the injury occurred, and regardless of whether they had SGLI coverage.





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How Does A Member Make A Claim For TSGLI?

In order to make a claim for the TSGLI benefit, the member (or someone acting on his or her behalf) should:

1. Download the SGLV-8600, Application for TSGLI Benefits . You can also obtain this form from the your service department point of contact or from the Office of Servicemembers' Group Life Insurance by toll-free phone at 1-800-419-1473 or by email at [email protected].
2. Contact your service department point of contact to begin the certification process.

The TSGLI Application has two parts:

• Part A is to be completed by the Servicemember or, if incapacitated, by the member's guardian, or the member's attorney-in-fact.
• Part B is to be completed by the attending medical professional.

Once both parts of the application are completed, the application should be sent to the appropriate branch of service TSGLI office listed on the first page of the application.



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Will The Service Member Ever Have To File More Than One Claim?

Yes. There are certain situations when the member will have to file more than one claim.

• For losses such as coma or traumatic brain injury, the TSGLI benefit is payable in $25,000 increments on the 15th, 30th, 60th, and 90th consecutive days of the member's inability to carry out activities of daily living. A separate claim for TSGLI must be filed at each time interval. For example, if a Servicemember suffers a traumatic injury that leaves him in a coma, a claim for TSGLI should be filed after the 15th consecutive day of the member being in a coma for which $25,000 is payable. If the member remains in a coma for 30 days after the traumatic injury, another claim should be submitted and another $25,000 will be paid.
• If a member files a claim for an incurred loss and then subsequently incurs another loss as a result of the same traumatic event, a new claim must be filed for the subsequent loss. For example, if a member files a claim for losing one leg as a result of an explosion and four months later has the other leg amputated as a result of that same explosion, the member must file another claim for the loss of the leg.

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May A Service Member Appeal If He or She Applies For A TSGLI Benefit And Is Denied?

Yes, a Servicemember may appeal if denied TSGLI.

1. If the Servicemember is appealing a decision based on eligibility criteria such as their loss or the circumstances surrounding the traumatic injury causing the loss, the Servicemember should contact the appropriate service department point of contact.
2. If the Servicemember is appealing a decision based on whether they had TSGLI coverage at the time of the traumatic injury, the Servicemember should contact the Office of Servicemembers' Group Life Insurance at 1-800-419-1473 to file an appeal.

All appeals must be in writing and must be filed within one year of the date of the denial.

 

[Jason Perry]

Claim being filed TBI with ADL
Ok, After being on the phone with several different people today getting a lot accomplished I need a question answered while I put all my records together tonight I have the DA Form 199 from my original med board I don't have real proof of anything really until after I left the Army. That form and what little bit that's on there is it going to be enough to show while I was in the army I had problems? After the Army all my VA stuff shows it all and my further DA forms 199 from my second eval and my last eval it's in there but not straight forward.
I don't have Active Army med records to show my adl's and I don't think it would even be in there since in 2006 and 7 they didn't give a shit about that like they do now. I also don't have any psych records from then either not going that far back its not possible either tried so am I screwed or do I have enough supporting documents of the last several years 2 months after I was boarded in the military and my Dr says she's gonna write it up wrapping it up since the military because but it t's obvious why I was medically retired from the army but am dreaming that this is gonna work....

It is extremely difficult to guess about whether you have "enough" evidence without reading all of the evidence. But, if your doctor is writing up something that describes your situation for the period of time you are applying for, then that would seem to be very helpful.

I tend to think that the DA 199, if it was silent on the issue of ADL's, is unlikely to be very helpful. Maybe you have records from the VA?