SGLV Form 8284
Traumatic Injury Protection Claim (TSGLI)
Who fills it
service-member-active
Journey phase
Filing Your Claim
Estimated time
30-45 minutes plus medical documentation gathering.
When to file
As soon as possible after the qualifying traumatic loss is documented.
You sustained a qualifying traumatic loss while covered by SGLI (on active duty or within 2 years of traumatic injury).
Gather before you start
—Medical records documenting the traumatic injury and resulting losses
—DoD records confirming SGLI coverage at time of injury
—Physician certification of qualifying losses
—Statement of activities of daily living (if claiming ADL loss)
Attach with the form
—Medical records
—Physician certification (SGLV 8284a)
—Proof of SGLI coverage at time of injury
Section I - Service Member Identification
Blocks 1-5Name, SSN, rank, branch, unitPII
Your identifying information at the time of the traumatic injury.
Example
(legal name, SSN, branch, rank at time of injury)
Common mistakes
- Not knowing TSGLI applies to traumatic injuries regardless of whether they are service-connected for VA disability purposes - TSGLI is insurance, not compensation.
Section II - Traumatic Injury Details
Blocks 6-12Date and description of traumatic event and resulting losses
Describe the traumatic event and the specific qualifying losses: (1) Total/partial loss of sight, (2) Total/partial loss of hearing, (3) Loss of limb(s) at or above ankle/wrist, (4) Loss of speech, (5) Severe burns (covering 20%+ BSA), (6) Inability to perform ADLs for 15+ consecutive days (bathing, dressing, eating, toileting, transferring). Include medical documentation for each claimed loss.
Example
e.g., IED blast on 03/15/2021; traumatic amputation of right hand above wrist; hearing loss in both ears; unable to perform bathing/dressing/toileting independently for 45 consecutive days.
Common mistakes
- Not claiming ADL losses - inability to perform basic self-care for 15+ consecutive days is a qualifying loss even without limb amputation or vision loss.
- Not submitting SGLV 8284a (physician certification) with the claim - required documentation.
- Missing the 2-year filing deadline from the date of the traumatic injury.
Authority
38 USC 1980A - Lump-sum TSGLI for qualifying losses (vision, limb, paralysis, ADLs).
Section III - Certification
Blocks 13-14Claimant signature and datePII
Sign and date. File through your branch TSGLI program manager.
Example
(signature/date)
Common mistakes
- Not working with your branch TSGLI office - they coordinate the claim with medical reviewers.
Statutory & regulatory authority
38 USC 1980A - Lump-sum TSGLI for qualifying losses (vision, limb, paralysis, ADLs).