The TSGLI process consists of four possible steps:
Initial Claim Submission
If your claim enters the appeal process, it’s most commonly resolved by clarifying the medical evidence, not by adjudication of a legal position. There is no additional charge for claims that require intensive administrative support or concentrated medical advocacy during an appeal. Our experts will advocate on your behalf through all levels of appeal.
1. Apply for Reconsideration - You may gather additional supporting documentation and request reconsideration of your claim.
2. Appeals Board - If your claim is still denied, you can supply additional documentation and appeal your claim to your service branch TSGLI Appeals Board.
3. Service Branch Review Board - Your third level of recourse is to apply to your service branch Review Board Agency.
Did you know . . . . .
The most common reasons claims are denied are for insufficient medical evidence or incomplete administrative glitches. Our nurse practitioner with military medical experience excels in this category, and fully understands what is required to submit a successful claim. This effort is enhanced by her knowledge and willingness to reach out to providers; such as orthopedic surgeons, burn specialists, physical or occupational therapists, to acquire clarifying evidence, if necessary.
You might believe filling out TSGLI insurance claims is pretty straight forward, but it’s not. There are a host of potential challenges. For example, does the military or civilian physician understand TSGLI policy, or have they kept up with policy updates? Did the provider take the time to submit the substantial medical evidence to support your claim? This effort is very time consuming, and may take days or weeks to accumulate the evidence.
Best example of an incorrect claim I corrected on behalf of an active duty Marine:
The military provider filled out a TSGLI claim for ADL losses attributable to an auto accident, though neglected to submit proper medical documentation. The physician also submitted the claim for “future ADL losses,” recognizing his patient would have an extended rehabilitation. Both were incorrect submissions, and the claim was denied.
The right answer was to submit the claim for amputation of his limb, and the Marine was awarded $50K.