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Traumatic Service Group Life Insurance (TSGLI) Appeals: Getting the Help You Need
From Our Columnist, Kyndra Miller Rotunda*

Kyndra Rotunda
Archive Columns

Not surprisingly, one lesson we've learned in the Global War on Terror is that military families will do anything -- and everything -- to be with their wounded loved ones.

Beginning with the first plane load of wounded troops to Walter Reed, family members travelled from all over the U.S. to welcome their beloved troop and help ease their pain. Some family members quit jobs they couldn't afford to quit; embarked on thousand mile journeys from coast to coast; and incurred costly hotel and dining expenses to remain at Walter Reed, while their soldier recovered.

Realizing the tremendous financial strain on families of the combat wounded, in 2005 Congress passed the Traumatic Service Group Life Insurance (TSGLI) benefit to help wounded troops and their families offset the expenses associated with being traumatically injured. TSGLI provides a one-time, lump sum, cash benefit that ranges from $25,000.00 to $100,000.00 depending on the particular injury.

TSGLI is not the same thing as Military Disability Benefits. Even troops who fully recover and return to active duty may still qualify for TSGLI benefits –though they do not qualify for permanent disability benefits. A troop who is permanently disabled may be able to collect both.

Who is eligible for TSGLI Benefits?

To qualify for TSGLI, the soldier must have incurred a "traumatic injury" caused by a "traumatic event."

The Department of Defense has published what it calls a "schedule of losses." That schedule specifies certain awards for certain injuries. For example "loss of both hands at or above the wrist" automatically qualifies for a $100,000.00 payment. The same is true of "loss of both feet at or above the ankle."

The Catch-All Provision:

But, what about those soldiers whose injuries don't fit perfectly into the "schedule of losses?" Can they still possibly qualify? The answer is: Yes.

The TSGLI regulations also include a catch-all (or safety-net) provision to compensate traumatically injured soldiers whose injuries aren't enumerated in the DoD "schedule of losses."

Under this category, soldiers qualify for TSGLI if their injury is not spelled out in the "schedule of losses" yet they are unable to carry out specified "activities of daily living" or "ADLs".

Wounded troops who are unable to independently perform two of six ADLs for at least 30 days qualify for the benefit. These ADLs include bathing, continence, dressing, eating, toileting, and transferring to/from a bed or a chair.

Unfortunately, all branches of the military, without any legal authority to do so, impose a stricter test than what the law actually requires. It denies TSGLI benefits to many wounded troops on grounds that the troop was not "completely dependent on another human being" to perform activities of daily living. But, the legal standard is much lower -- the legal standard is -- "unable to independently perform" two of six ADLs.

Do I Need A Lawyer?

When the military denies TSGLI benefits, it allows the wounded troop several appeal opportunities. However, unless the solider is able to present supporting evidence, the military typically denies the troop benefits at every level of appeal.

Unfortunately, because the military denies so many claims that are entitled to recovery, troops are forced to hire lawyers; or forfeit benefits they're entitled to receive. But, lawyers are expensive and most legal practitioners don't have any experience with TSGLI appeals.

Pro Bono Help on the Horizon:

I am a law professor at Chapman University School of Law in Orange, California. I'm a soldier, too. I've helped hundreds of soldiers receive benefits that they're entitled to receive.

Chapman University Law School is seriously considering the possibility of launching a military law clinic where law students – working under my direction and also with qualified supervising attorneys – would represent military families in various civil disputes.

We would accept TSGLI appeals.

Anyone interested in learning more about Chapman's efforts to launch a Military Personnel Legal Support Center should contact me directly at krotunda@chapman.edu.

   



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