by Guest » Fri Jul 12, 2013 12:02 am
My name is Daniel. I had a traumatic Injury to my back while on a deployment in Iraq that resulted in a ruptured disk at my L-5 S-1 level, as well as a herniated disk above and below that. I went through every non surgical procedure to help fix my pain, none of which had any success. I emded up having to have a spinal fusion with a bone graft as a result of my injuries because I was unable to function independently. I suffered at least 2 of the 6 scheduled losses of ADL for 30 consecutive days prior to my surgery, and a minimum of 3 of the 6 scheduled losses of ADL for an additional 30 days post surgery. I have read the ENTIRE TSGLI handbook back to back 3 times, but can't find ANY info about if the recovery from surgery is included in the "consecutive days in a row", if the surgery was performed to fix the traumatic injury I suffered. The losses of ADL I had where transferring, dressing, and bathing, all of which were due to my inability to bend down for dressing, showering, or getting up and down down bed or couch/chair. So... If I had a back injury in which I suffered the required number losses for ADL, but some of those days where also in lue of my recovery from surgery due to my back injury, can I include my days of recovery as consecutive days as well?? If anyone has gone through this type of situation any advice would be
Thank you,
Daniel
Thank you,
Daniel
Posted: Fri Jul 12, 2013 04:26 pm Post Subject:
According to the TSGLI chart of payments, you are looking at a Part II Loss. The benefits under those two last categories of payments are:
20. Traumatic injury resulting in inability to perform at least 2 Activities of Daily Living (ADL)
at 30th consecutive day of ADL loss = $25,000
at 60th consecutive day of ADL loss = an additional $25,000
at 90th consecutive day of ADL loss = an additional $25,000
at 120th consecutive day of ADL loss = an additional $25,000
21. Hospitalization due to traumatic injury
at 15th consecutive day of hospitalization = $25,000
If your injury was considered traumatic, and you suffered an inability to perform any two of the six ADLs, whether you had surgery or not does not seem to be a criterion. Simply a count of the "consecutive days" of disability. What I did see was that the days are measured from the date of injury (as in removal from the battlefield), and include the day of transportation to a hospital, days of admission, and day of discharge. Your situation may be somewhat different, because it does not appear to be continuous from the date of injury. Like you, I don't find information that may cover your particular situation.
Have you made a claim for benefits? If not, you should. If you have, you should receive (or have already received) an Explanation of Benefits from Prudential, which manages the SGLI program. If you receive (or have received) an "adverse" benefit determination (a denial of your claim), there will be an administrative appeals process that must be followed closely to preserve your rights. You cannot miss stated deadlines.
You may need some more directed advice from someone with this kind of experience with SGLI. Have you looked as the resources available from Wounded Warriors? They have a great track record of helping Vets obtain the benefits they paid for, fought for, and were injured in the process. Their website is www.woundedwarriorproject.org
Another possible resource is www.fallenheroesfund.org
As the father of a US Marine now in his 18th year of service (as of July 5), I salute you for your service and sacrifice.
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