TSGLI Medical Claim Denied

Appeal for a Denied TSGLI Claim

Different Levels of Appeal for a Denied TSGLI Claim

If your initial TSGLI claim application is denied, there are three levels of appeal for a Denied TSGLI Claim.

First Level of Appeal – Reconsideration

If you decide to appeal, you must do so in writing. In addition it must be with a 1st Notice of Disagreement to your branch of service point of contact. Then your appeal goes through the first level of the internal review process within your branch of service. This process is called a reconsideration and is done within the branch of service TSGLI office.

  • What if the decision is made to overturn the original denial decision on the certified claim? The claim is re-certified to the Office of Servicemembers’ Group Life Insurance (OSGLI) and the claim is paid.
  • What if the decision is made to uphold the original denial decision on the certified claim?  You will be sent a letter by your branch of service informing you of the decision and the next steps you can take to appeal the decision.

Second Level of Appeal

If you decide to appeal further, you will need to submit a 2nd Notice of Disagreement to your branch of service point of contact. Then your appeal goes through the second level of the internal review process within their branch of service.

  • What if the decision is made to overturn the original denial decision on the certified claim? The claim is re-certified to OSGLI and the claim is paid.
  • What if the decision is made to uphold the original denial decision on the certified claim?  You will be sent a letter by your branch of service informing them of the decision.

Third Level of Appeal

If you decide to appeal further, you will need to submit a 3rd Notice of Disagreement to your branch of service point of contact. The member’s appeal goes through the third level of the internal review process within their branch of service.

  • What if the decision is made to overturn the original denial decision on the certified claim?  The claim is re-certified to OSGLI and the claim is paid.
  • What if the decision is made to uphold the original denial decision on the certified claim? You will be sent a letter informing you of the decision and that your last resort in the appeal process is suing in federal court.

Do I have the right to sue in Federal Court?

In addition to utilizing the administrative appeals process, members have the right to file suit in federal court. To contest an adverse TSGLI decision.   In the event a member files suit in federal court, the branch of service must provide OSGLI with any documents.  As well as any records relating to the initial TSGLI denial and any subsequent appeals.

TSGLI Procedures Guide Version 2.40: March 10, 2017 | Page 75

The TSGLI appeals process can be time consuming and confusing.  Therefore, it is in your best interests to hire a qualified TSGLI attorney to handle your TSGLI claim.  At the Law Office of Peter S. Cameron, APC. we handle TSGLI cases nationwide.  So call us today at 800-861-7262 for a free consultation or simply submit our secure on line claim 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.