Eligibility | Mysite

TSGLI Eligibility

Am I Eligible?

There are two categories for consideration: A service member who incurred a qualifying traumatic injury while on orders in a combat zone between 10 October 2001 and 30 November 2005 may be eligible for TSGLI benefits; and more broadly, after Dec 1, 2005, service members who elected to enroll in SGLI (Service members’ Group Life Insurance – SGLI) and incur a qualifying injury may be eligible for TSGLI benefits. It is very common for service members to be unaware of this coverage and sadly miss out on a potential financial benefit.

What Is a Qualifying Traumatic Injury?

An injury to the body must be caused by an “external energy or force,” which is identified as the traumatic event OR a condition that is directly linked to the traumatic event, such as a heat or training injury. Most claims are submitted for 15 days of consecutive inpatient hospitalization, often with injuries attributable to head or facial injuries, loss of sight, hearing or speech, broken bones, amputations, paralysis, or burns.

Another very challenging claim that benefits from our medical professionals are those associated with extended recovery and decreased activities-of-daily-living or ADLs. This category is an example of where our team excels in examining the evidence to determine your eligibility.

What Are the Five Basic Eligibility Requirements?

You must be insured by SGLI when you experienced the traumatic injury.
You must incur a “scheduled loss or medical condition,” as a result of your traumatic injury which meets TSGLI policy criteria. (See Scheduled Losses and Eligible Medical Conditions below.)
You must have suffered the injury prior to midnight of the day you separated from the uniformed services.
You must have suffered the “scheduled loss,” within 2 years or 730 days from the date of your accident.
You must survive for a period of 7 full days from the date of injury to receive TSGLI benefits.

Scheduled Losses and Eligible Medical Conditions

In order to be eligible for payment, medical conditions or “losses” must meet the TSGLI standard with sufficient medical evidence to be submitted with the claim. There are nine categories of losses covered:

Sensory losses, such as permanent hearing loss, blindness, or loss of speech
Burns, 20% of face, or 20% total body surface area
Permanent paralysis
Amputation from original injury, or elective amputation from failed medical interventions
Limb salvage
Facial reconstruction
Activities of Daily Living (ADLs)
Genitourinary losses
15 days consecutive inpatient hospitalization *May initiate from date of injury, or within the 730 day window from date-of-injury due to worsening medical status
(See Scheduled Losses at Department of Veterans Affairs for more details.)

The following are examples of injuries that would NOT be covered under TSGLI:

An injury which occurred while attempting suicide or self-inflicted injury.
An injury that occurs due to medical or surgical treatment of an illness.
An injury while under the influence of an illegal or controlled substance unless administered or prescribed by your doctor.
An injury which occurred while committing or attempting to commit a felony.