TSGLI appeal process HELP!

C

cming

Member
Registered Member
Hello everyone I am new to this forum and have a quick question. I was denied my TSGLI because and I quote "Because evidence indicates your hospitalization was not 15 days in length". I have filed a claim before and I was only in the hospital for 9 days. So this reason does not make since to me. Now my question is: How long does the appeal process take and is there a fast way to complete this claim?
 
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.
 
In recent conversations I am beginning to suspect that the services are not documenting the medical files, or the applicants are not extracting sufficient materials from the files and are therefore failing to create medical reports which match the TSGLI criteria. From the individuals I have interviewed , that does not indicate a lack of qualifying traumatic injuries, but rather a failure to match the objective indicia of injuries and relating those injuries to the TSGLI standards. In cming's situation, the period of hospitalization is probably of little significance. It is the injuries treated and persisting which either qualify or they do not. That is the area you should look to in your appeal. Do you claim a qualifying injury for a specific period of time where the activities of daily living were compromised? How do you propose to objectively corroborate that claim of injury? The medical records should be a starting point, not the alpha and omega of the claim. What can you take out of the medical records, or videos, or photos of that time, which give you a starting point to expand on the limitations or the origin of a present condition?
 
We have been appealing for 6 years. My husband was in the
Hospital for 3 months. We were sent to live in the Malagone
House for 10 months. He was unable to bath him self use the
Bathroom, transfer, or get dressed with out my help for well over
A month of discharge. Then had a surgery every other month for
A while. So we got 3 installments. But they gave us a letter saying
He didn't have a loss for the last installment. So irritated. Anyone
Know what to do. He is at 90% disability and doesn't work. At wits end!
 
Have you appealed or tried to have his VA claim increased? Applied for individual unemployability through the VA?
 
If he gets 100% doesn't he loose his social security disability? We did try a while back. It is just appeal after appeal.
 
Michee21 said:
If he gets 100% doesn't he loose his social security disability? We did try a while back. It is just appeal after appeal.
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No........VA money doesn't impact SSDI. Also, if you have children he can receive another 50% of his SSDI award for them.
 
Well denied again. Told I have exausted my appeals. Now to the
Army review board. With no flipping help. I have no clue what the hell they
Are looking for. Anyone know who to talk to?
 
Hi All,
I am new to this page, but I hope that I can get some advice on what we should do concerning this TSGLI. In 2009, my husband suffered a broken back, on the base, as the result of lifting a ration pan filled with water. He broke is back in 3 places. After the initial shock, I went online and started looking for some type of assistance because he was the only one working in our family. I saw the information regarding the TSGLI insurance, and so I filed and the doctors filled out their portions. Sent it in and it was denied. Anyway, we appealed it and again it was denied! Now, I have a problem, I have went beyond the appeal date (January 2013), and I need an attorney, from Michigan, that will assist me in filing a suit in court. I don't know of any military attorney's. Would anyone on this page know of any? Thanks!
 
I have one word, Congressman or Congresswoman in you state!!! After all they work for you, and they are excellent advocates for Soldiers! I live in Alabama, and My congressman get things done for me. What I did was went to their office, did a short statement concerning the issues, and provided all supporting documents. The time frame depends on the issues. For example I did a Combat Related Special Compensation (CRSC) case concerning my "presumptive" illnesses. That time frame with results takes 2 to 3 months or less. I'm a happy camper! I am 100% Army, VA, SSDI, DoD FERS Civilian. Now I am just awaiting my CRSC. Oh by the way if you are applying for CRSC, make sure you are not doing a buy back for civilian credit while awaiting CRSC. If so, you will be denied for CRSC.
 
pepper44 said:
I have one word, Congressman or Congresswoman in you state!!! After all they work for you, and they are excellent advocates for Soldiers! I live in Alabama, and My congressman get things done for me. What I did was went to their office, did a short statement concerning the issues, and provided all supporting documents. The time frame depends on the issues. For example I did a Combat Related Special Compensation (CRSC) case concerning my "presumptive" illnesses. That time frame with results takes 2 to 3 months or less. I'm a happy camper! I am 100% Army, VA, SSDI, DoD FERS Civilian. Now I am just awaiting my CRSC. Oh by the way if you are applying for CRSC, make sure you are not doing a buy back for civilian credit while awaiting CRSC. If so, you will be denied for CRSC.
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Welcome to the PEB Forum! :)

Good information and good deal! Enjoy! :cool:

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
pittpan2005 said:
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.
Click to expand...



Hello! :) I am not trying to hijack a thread, but I am new to this forum and no clue how to post a new thread. My question(s).....My husband is career military. He has 11 years in. He was injured in a training exercise. Long story shortened: when he first filed, he had one major surgery for this injury. He has now undergone 2 major donor surgeries, because the first one didn't "work" and he had to have another. He now has the second surgery to add. He filed a TSGLI claim and it was denied. What is the best way to go about appealing it? What would a letter need to include? Also, do you know if he would need to include the entire medical record again or just the newest findings, surgical reports, labs. ANY help in this matter would be nothing short of amazing!! Thank you.
 
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