TSGLI Claim Denied? Here’s Why It Happens and What You Can Do About It
TSGLI—short for Traumatic Servicemembers’ Group Life Insurance—was created to protect the men and women who serve in the U.S. military when they suffer life-altering injuries. On paper, it sounds like a clear and compassionate benefit. But in reality, TSGLI claims are denied far more often than most service members expect. These denials frequently occur during the most vulnerable times, when injured veterans and their families are struggling to adapt to life after a traumatic event.
Whether you’re serving in the Army, Navy, Air Force, or another branch, your TSGLI coverage should be there when you need it most. Unfortunately, vague requirements, strict documentation rules, and overly technical definitions of "qualifying losses" often result in legitimate claims being denied. If that’s happened to you or someone you care about, know this: you’re not alone—and you have legal options.
Why Do TSGLI Claims Get Denied So Often?
TSGLI coverage is triggered by a traumatic injury that results in a “scheduled loss”—a list of injuries and conditions outlined by the Department of Veterans Affairs. These include amputations, loss of vision or hearing, coma, paralysis, or inability to perform basic activities of daily living (ADLs) such as bathing, dressing, or eating without help.
But the burden of proof is entirely on the claimant, and the requirements are stricter than many realize. Even when a service member clearly suffered a catastrophic injury, their claim may be rejected due to documentation issues or disputes about the severity or cause of the injury.
Here are some of the most common reasons TSGLI claims are denied:
Eligibility Timing Issues
The injury must have occurred while the service member was insured under SGLI. If the injury took place before coverage began, after it lapsed, or during a period of ineligibility, the claim will be denied. Disputes often arise over what counts as a qualifying event during active duty or certain types of leave.Incomplete or Incorrect Descriptions
Claims often fail because the paperwork lacks clarity or consistency. Medical records and forms must clearly describe the injury, the treatment, and the functional impact. If the documentation leaves room for doubt, the VA may interpret it in the insurer’s favor.Misclassification of Injury
Some claims are denied because the injury does not fall within the defined TSGLI “schedule of losses.” This is particularly common in cases involving brain injuries or psychological trauma, where the symptoms are harder to measure. If the VA believes the condition was exaggerated or not properly diagnosed, they may reject the claim entirely.Failure to Prove ADL Impairment
For many claims—especially those involving non-visible injuries—the key requirement is that the service member was unable to perform at least two activities of daily living without help for a minimum number of days. If records don’t explicitly confirm this, the claim will likely be denied—even if the impairment was obvious.
What Injuries Are More Likely to Be Approved?
While every claim is evaluated individually, certain injuries tend to be accepted more readily due to their clarity and severity. These include:
Amputation of one or more limbs
Loss of eyesight or hearing
Severe burns requiring hospitalization
Comas lasting over 15 days
Paralysis of one or more limbs
Inability to perform at least two ADLs for a set period (15–120 days)
Even in these cases, approval isn’t guaranteed. Every detail of the injury, treatment, and recovery period must be documented thoroughly and meet VA standards. If your injury fits one of these categories but your claim was denied, it’s time to dig deeper and push back.
The Importance of Legal Help in TSGLI Denials
Most service members assume that if they’ve been through something life-altering, the benefits will follow. But the TSGLI system often requires injured service members and their families to fight for what should be automatic. Many claims are denied not because the injury doesn’t qualify—but because the documentation doesn’t “check all the boxes.”
That’s where we come in. Our law firm handles denied TSGLI claims nationwide. We help veterans gather the necessary documentation, work with medical experts to clarify complex injuries, and appeal VA denials that are based on technicalities rather than facts. If the VA continues to refuse your claim unfairly, we’re prepared to take it to federal court.
You served your country. You don’t deserve to be denied the benefits that are supposed to be there when you need them most.
FAQ: Denied TSGLI Claims
What is TSGLI?
TSGLI stands for Traumatic Servicemembers’ Group Life Insurance. It provides a one-time payment (usually between $25,000 and $100,000) to service members who suffer qualifying traumatic injuries.
How do I know if my injury qualifies?
Your injury must meet the VA’s criteria for a “scheduled loss.” This could include amputation, coma, paralysis, or loss of ability to perform ADLs. Even if you believe it qualifies, the VA may deny the claim without detailed medical documentation.
Why was my TSGLI claim denied?
Claims are most often denied due to eligibility issues, vague or incomplete paperwork, or injuries not fitting the program’s strict definitions. Many denials are based on technicalities, not the legitimacy of the injury.
Can psychological injuries or PTSD qualify?
While mental health conditions alone typically don’t qualify, they may if they result in a physical loss or inability to perform ADLs. Each case depends heavily on documentation and diagnosis.
Can I appeal a denied TSGLI claim?
Yes. You can request reconsideration, submit an appeal through the VA, and even pursue legal action in federal court if necessary. Having an experienced TSGLI attorney significantly increases your chances of success.
If your TSGLI claim was denied, don’t give up. Contact our firm for a case review—we’re ready to help you fight for the benefits you earned.