DENVER (CN) – Eight injured Army veterans claim in court that the federal government denied their medical claims and “has standardized the practices of denying claims [from injured veterans] in a manner that is arbitrary, unsupported by its own guidelines and contrary to law.”
Lead plaintiff Dannie Fail claims the Army’s Servicemembers Group Life Insurance Traumatic Injury Protection (TSGLI) program, routinely denies benefits to injured veterans and forces them through an appeals process to get disability benefits.
Similar lawsuits have been filed across the country.
All eight plaintiffs say their injuries were certified by a medical professional.
The complaint does not detail the specific injuries each veteran suffered, but it does list the injuries that qualify them for TSGLI benefits: “There are nine categories of losses covered as follows: 1) Sensory losses, 2) Burns, 3) Paralysis, 4) Amputation, 5) Limb salvage, 6) Facial reconstruction, 7) Activities of daily living, 8) Inpatient hospitalization, 9) Coma/TBI [traumatic brain injury] combined with another injury.”
When injured vets seek coverage, the plaintiffs say, the United States “adds a criterion negating ADL [undefined] coverage where there can be adaptive behavior to accomplish the activity, even though the adaptive standard is not contained in the manual or guideline.”
All right plaintiffs say they followed the government’s requirements, including getting letters from independent doctors certifying that their “traumatic injuries” left them unable to work. All were denied benefits.
“(A)ny member who receives an adverse TSGLI decision may obtain judicial review in any United States District Court of competent jurisdiction,” the complaint states.
“In addition, even if administrative reviews were required of TSGLI applicants prior to initiating a lawsuit, doing so would be futile because it is certain that a TSGLI claim will be summarily denied on appeal for the reasons stated herein.”
Plaintiffs Danny Fail, Scott Buchholz, Christian Andersonn, John Zonta, Stacey Truax, Timothy Melson, Scott Philbrick, and Jedadiah Zillmer all live in Colorado.
Their lead counsel is L. Dan Rector of Colorado Springs.