Reasons For TSGLI Denials – ADL Loss

TSGLI applications can get denied for many reasons. Some of the most common seem to revolve around the loss of activities of daily living (ADL). Typically, if a service member files a TSGLI claim for a loss of limb or severe injury, their TSGLI claim may be paid without the need for reconsideration and/or appeals. Unfortunately, one of the more difficult qualifying losses to prove revolves around ADLs.

There are six (6) ADL’s:

1. Bathing
2. Continence
3. Dressing
4. Eating
5. Toileting
6. Transferring

To establish a TSGLI claim, a service member must prove that he/she has suffered two of the six above-mentioned qualifying losses for a certain period of consecutive days. ADL loss requires assistance. The service member must be unable to independently complete at least two of the six ADLs. The qualifying loss period for ADLs is measured in intervals of 30-days, with a maximum of 120-days. Each consecutive amount of days is equal to $25,000, with a maximum payout of $100,000.

ADL Loss Period:

• • 30-days – $25,000
  • 60-days – $50,000
  • 90-days – $75,000
  • 120-days – $100.000

A service member must prove that he/she suffered a qualifying loss for at least two of six ADLs for a certain number of consecutive days. The challenging part about proving loss of ADLs is that many civilian doctors do not record a qualifying loss within their notes, even though the service member has been told orally that he/she needs assistance to perform certain ADLs and upon review, the doctor would agree that the servicemember suffered a qualifying loss. Doctors are paid to get you better, and sometimes, may not record the day-to-day of your injury and their instructions.

When a doctor fails to properly notate a servicemember’s medical records, the servicemember’s claim may be denied. The burden to prove a qualifying loss is on the servicemember. If the servicemember’s doctor does not describe the servicemember’s limitations in detail and establish a certain loss period, the servicemember’s claim may be denied.

An attorney will help a servicemember establish their TSGLI claim by submitting evidence, medical documents, reviews, analysis, and case law to prove that your loss meets the standard for TSGLI benefits. TSGLI benefits can be tricky to prove. The government looks for specific injuries, consecutive days, and certain proof before it pays claims.

Brochu Law, PLLC represents TSGLI Claims on a contingency fee basis. There is no fee unless you win. We advance all costs on behalf of military families and consumers.

Brochu Law, PLLC represents military families and consumers nationwide*

*Disclaimer –Christopher J. Brochu, Esq. is licensed to practice law in the State of Florida. Brochu Law, PLLC works with co-counsel in accordance with state and federal law.