TSGLE Standards Traumatic Brain Injury

TSGLI Loss Standards for Traumatic Brain Injury

What are the TSGLI Loss Standards for Traumatic Brain Injury?

This article is details TSGLI Loss Standards for Traumatic Brain Injury.  Find out about Required Assistance, who is eligible and what to do if your claim is denied.

Eligibility for a TSGLI benefit for inability to perform Activities of Daily Living (ADL) due to traumatic brain injury is dependent on certain conditions. Inability to complete these following tasks will make you eligible.

The member is unable to independently perform at least two of six ADL (bathing, continence, dressing, eating, toileting and transferring) and the member’s inability lasts for at least 15 consecutive days.

The member is considered unable to perform an activity independently if he or she REQUIRES assistance to perform the activity.

REQUIRES Assistance Is Defined As

Qualifying as ‘Required Assistance’ can be broken down into different categories.

  • Physical assistance – when a member requires hands-on assistance from another person
  • Stand-by assistance – when a member requires someone to be within arm’s reach because the patient’s ability fluctuates and physical or verbal assistance may be needed
  • Verbal assistance – when a member requires verbal instruction in order to complete the ADL due to cognitive impairment. Without these verbal reminders, the member would not remember to perform the ADL.

Without this physical, stand-by, or verbal assistance, the member would be incapable of performing the task.

Accommodating Equipment 

The member is NOT considered unable to perform an activity independently if he or she is able to perform the activity by using accommodating equipment. Such as a cane, a walker, or a commode, etc.  The ability to perform activities using these accessories would disqualify one from benefits. 

The benefits available are similar to the benefits for Coma:

On the 15th consecutive day of ADL loss the benefit is $25,000

There is an additional $25,000 benefit on the 30th consecutive day of ADL loss

On the 60th consecutive day of ADL loss there is an additional $25,000 benefit

And on the 90th consecutive day of ADL loss there is an additional $25,000 benefit

Many TSGLI claims are initially denied.  Contact the Law Office of Peter S. Cameron at 800-861-7262  for legal advice and help with filing your TSGLI claim.  If you prefer, simply submit our secure online form for a prompt reply.  Because, we are here to help you.

This article is for educational and marketing purposes only.  Consequently, it does not create an attorney-client relationship.