TSGLI Claim Denial
Servicemen and women are the lifeblood of the U.S. military who put their lives on the line for our nation no matter the danger or odds. They defend us in the most dangerous situations and do so for little pay but great love of country. Our nation’s history is full of acts of heroic sacrifice by members of all branches of our armed services to ensure that liberty continues to flourish and that our democracy is preserved against threats that could end our way of life. Our servicemen and women deserve our thanks but also our support when they come home after honorably serving our country and safeguarding the liberties every American enjoys.
However, some servicemen and women don’t make it home as they left because they indeed made a significant for our country and our freedom. Some servicemen and women receive great medical care but need more help after sustaining a traumatic injury as they were defending our country. During their term of service to our nation, many wisely decide to enroll in the Servicemember’s Group Life Insurance policy (SGLI) which provides benefits to their loved ones once the servicemember passes away. When they do, it opens the door to the Traumatic Servicemember’s Group Life Insurance Policy (TSGLI).
Unfortunately, sometimes a servicemember is subject to a TSGLI claim denial through no fault of their own. After years of defending our nation, a TSGLI claim denial can feel like a slap in the face to the servicemember and their family who are dealing with a terrible situation that cannot be easily remedied. Below you’ll find some answers to common questions regarding TSGLI claim denial and reasons why you should call our office today so we can help you fight that TSGLI claim denial.
What is TSGLI and what does it stand for?
TSGLI, also known as the Traumatic Servicemember’s Group Life Insurance, is a policy designed for servicemen and women who are traumatically injured while serving our nation. This policy is a helpful boon to those who may not have the financial resources to pay for care outside of the traditional care a traumatically injured veteran returning home would get. For so many, this policy is the difference between substantial ruin and a lifeline for expenses no one anticipates they will ever have to deal with. Knowing that this is such a necessary program for thousands of American servicemember families, we know a TSGLI claim denial can be particularly painful.
What is a typical TSGLI payment?
While there is no ‘typical’ TSGLI payment given that every serviceman or woman can choose their own policy and how much to pay into it, a TSGLI payment can range from a low of $25,000 to a high of $100,000. Some TSGLI policies even have provisions for additional payments for care during a coma, hospitalizations, or inability or perform activities of daily living. Needless to say, these services are costly and are often long-term needs for the servicemember. Most American families cannot afford to independently pay for these services out of pocket if they are subject to a TSGLI claim denial.
What injuries are covered under TSGLI?
Many injuries a servicemember can sustain in the course of defending our nation are covered under a TSGLI policy which gives them some hope for treatment if the worst happens. The loss of hearing, sight, speech, amputations of hands, legs, feet toes, attempting to salvage a limb, reconstruction of the face no matter if it’s the jaw, nose, ears, tissue or other issues. Additionally, it covers injury that then prohibits the servicemember from performing two activities of daily life, which in addition to being a struggle, can be embarrassing for the formerly strong servicemember. This also demonstrates the catastrophic nature of the injury that such severe conditions are covered making a TSGLI claim denial a particular hardship for a family.
Why would my TSGLI claim be denied?
There are a multitude of factors for a TSGLI claim denial up to and including improper paperwork or another mistake on the part of the person tasked with approving your claim. They could also make the decision for a TSGLI claim denial based on someone not being eligible for or enrolled in SGLI and thus being ineligible for TSGLI given that a person must be eligible for the overarching program to be eligible for the other. Another reason may be some confusion or debate as to the start date of the program and whether the injury occurred during the time period TSGLI was in effect. An additionally reason could be that the injury was not classified in a proper way, there may not be a correct description of a medical issue, or a bevy of other problems. No matter the reason why a TSGLI claim is denied, receiving a TSGLI claim is painful for those who have to live with a traumatic injury in day to day.
What can I do to fight a TSGLI claim denial?
Working with our experienced attorneys, we can work to fight a TSGLI claim denial with all the available legal and medical resources at our disposal. From disputing the medical determination with doctors and other experts to debating the terms of the policy, our lawyers know how to appeal a TSGLI claim denial in a way that ensures you have the strongest possible chance of success given the individual facts of your case. You should know that when you need to appeal a TSGLI claim denial, you are not alone, and our firm is here to help you get the coverage you deserve to help make life as easy as possible.
What if I have more questions about a TSGLI claim denial?
For any questions, concerns, or guidance that you need regarding your TSGLI claim denial, contact our experienced attorneys immediately for help. No matter the reason for the TSGLI claim denial, our staff can help sort through the reasoning and get you the help you deserve. Call our office today for a free TSGLI claim denial consultation.
Receiving a denial for any kind of claim can be devastating. Depending on the policy and stipulations placed on the beneficiaries, it can be very easy for the insurance company to seemingly pull a denial out of thin air, and still have the evidence to back it up.
Unfortunately, this can happen all too often, no matter who, or what is being dragged into the case. This is even true when working with TSGLI policies, where the service members in question tend to not be given the slightest care when it comes for them to try to receive benefits after a severe injury.
This affects not only the beneficiaries, but also the policy holder. This is because TSGLI policies are not only upon death. TSGLI policies can payout even if the policy holder is still alive, as it is more about how grevious the wounds are. So, if a denial comes through, it can be devastating.
Reasons for Denials by the Insurance Company
There can be several reasons as to why the insurance company decided to try to send a denial of claims and have it pass. They can range from the obvious, to the not so obvious, to the almost blatant exploitation of your time and energy.
The largest and most pronounced reason that a delay or denial can come through on a TSGLI claim is due to the time frame as to which the injury occurred, relevant to the time that the policy went into effect. Many insurance policies will generally need to be active for at least a year or so with no incidents if the insured and beneficiaries wish to see a payout. With TSGLI, the time period before activation can be murky. The main reason this can be called into question is if the policy was enacted only a few months ago, and then the injury occurs. This would be probable cause to search for a possible intentional injury.
A very grey area is the type and extent of the injury. Depending on how deep the policy goes, it can come up that the injury itself does not qualify as a severe injury or traumatic injury. Depending on the amount of payment that is going into the policy, it can be noted that they will challenge this fact, and try to say that the injury is not that threatening, thus it doesn’t qualify for their payout.
How to fight the Denial
The first step is to gather all documents, records, and reports available on the injury and the policy. Ensuring that you have your own set of original papers means that you know that nothing will be withheld if you have to go to court against the insurance company.
Next is finding a proper life insurance lawyer or denied life insurance claim attorney to help represent and guide you through the entire process. Having an experienced attorney can help to confirm that you have a valid reason to challenge the denial, and get you the information necessary to make sure you don’t skip over any formalities that can be used against you.
Unsure of where to look? Having trouble figuring out who to talk to? Our attorneys here at our offices are specialized and experienced, having helped many people on their claims and facing denials. We know that you aren’t just another number on a checkbook, that you have your own lives, and just want to move on. We’re here to make sure you can do just that.