Many employers provide employees with the option to purchase group life insurance coverage in addition to basic coverage provided by the employer and paid for by the employer. This coverage, often referred to as optional, voluntary, or supplemental life insurance, does not, necessarily remain in place once the employee has left the company. As attorneys representing life insurance beneficiaries denied coverage, Trief & Olk sees many cases where the client’s loved one has passed away after a long illness. The beneficiary –such as a surviving spouse –seeks payment under the supplemental life insurance that had been in place while the deceased was employed, only to find out that the insurance company claims that the coverage had previously ended, so the insurance claim is denied. Challenges to such life insurance denials are possible, but must be pursued according to the specific procedural requirements of the Employment Retirement Income Security Act of 1974, known as ERISA, 29 U.S.C. §§ 1001-1461, the federal statute that governs insurance plans provided to employees as part of a benefits package.
Denials of life insurance coverage under employer-provided life insurance typically arise when the employee stops working due to a serious illness (such as cancer) that requires extensive treatment and makes the employee too ill to work. The employee eventually is required to go on long-term disability leave. She may continue to receive disability payments under the employer’s disability policy and therefore may assume that the life insurance coverage continues as well. Depending on the terms of the insurance plan, however, the employee’s coverage under the life insurance policy may end at a certain point. Frequently coverage ends one year after the employee first went out on disability, at which point the employee may no longer be considered an employee. The employer and insurance company cannot, however, simply cut off coverage. They must provide notice that the policy coverage will end and explain the employee’s options. For example, many policies require that the employee have the opportunity to convert the group policy to an individual policy (for which the former employee will be required to pay monthly premiums). Certain policies also offer the possibility of continuing coverage under the group policy beyond the standard cut-off date if certain conditions are met. In such circumstances, the employee may be able to apply for a waiver of the monthly premiums.
If you or a family member have recently stopped working due to a serious illness, it is important to find out from the employer what benefits –including life insurance coverage –continue while on disability, how long those benefits will continue, and what options are available if and when those benefits terminate.
If you recently lost a loved one who had employer-provided life insurance for which payment was denied, you may have a claim if the employer and/or insurer did not provide the proper opportunity to convert or extend the life insurance coverage. The life insurance attorneys at Trief & Olk are available to answer your questions and represent you if life insurance has been denied. Feel free to consult our website for examples of the many successes we have had when life insurance companies denied payment or call us directly at 212-486-6060 (NY) or(NJ) to discuss how we may help you.