Why Your Claim Was Not Approved
If you receive a letter denying your TSGLI benefits, usually a part of the letter will be under the heading “Why Your Claim Was Not Approved”.
In one recent case, Ms. K received such a letter and it read:
Your claim for inability to independently perform Activities of Daily Living (ADLs) due to traumatic injury (other than traumatic brain) was not approved because there is not enough medical information to support that you could not perform ADLs independently.
After Ms. K received this denial she filed for reconsideration. She had all the proper documentation to prove her losses after her traumatic injury. The TSGLI program declined to overturn its previous decision. This time the letter read:
“The application submitted only has the ADL loss of bathing claimed. According to TSGLI standards, as Servicemember must be incapable of performing two or more of the six ADLS for a period of 30 days or greater. Also, there was no supporting medical documentation submitted with your claim. We must have medical documentation, from the period for which you are claiming that supports your losses. Such documentation could include discharge summaries, nurse’s notes, occupation or physical therapy reports, etc.”
She continued to follow the proper appeal up to the Army Board for the Correction of Military Records but was always denied. Finally she took her case to US District Court. The court found that the Board’s decisions to deny her final appeal was
…arbitrary and capricious because the decision ran counter to the evidence presented.
There the judge vacated the decision of the Board and the case will be reconsidered.
DENIED YOUR BENEFITS?
If you have been denied your TSGLI benefits, let an experienced TSGLI attorney help you. So please call our office today at 800-861-7262. Or, if you prefer, use our secure email on our website for a prompt reply. Because we are here to help you.
This article is for educational and marketing purposes only. Therefore it does not create an attorney-client relationship.