Facing a denial of life insurance benefits under your employer’s plan can be overwhelming and emotionally draining. If you’ve recently encountered such an issue, it’s only natural to feel confused or worried about how to move forward. At times like these, you may find yourself wondering why your claim was denied or what steps you should take next to ensure you receive the benefits that were promised. It’s important to understand that these types of denials are not uncommon, and there is hope.
If you’re dealing with an employment-based life insurance denial and need help navigating the legal process, we are here to assist you. Our team at Trief & Olk is fully empathetic toward the frustration and distress you may be feeling right now. We understand how significant these benefits can be for you and your loved ones, and we are dedicated to fighting on your behalf to help you secure the compensation you deserve.
What is ERISA and How Does it Impact Employment-Based Life Insurance?
The Employee Retirement Income Security Act (ERISA) is a federal law that governs most employer-sponsored benefit plans, including life insurance. Under ERISA, employers are required to offer certain benefits to their employees, and this includes the responsibility of ensuring that these benefits are provided fairly. Unfortunately, despite the protections offered by ERISA, many beneficiaries find that their claims for life insurance benefits are denied or delayed.
ERISA provides specific guidelines for how these claims should be handled and allows beneficiaries to challenge denials through an appeals process. However, this process can be complex and frustrating, particularly when insurance companies use technicalities to deny claims. Whether you are the beneficiary of a life insurance policy or the individual whose benefits have been denied, understanding ERISA is essential to navigating these types of cases.
Common Reasons for Employment-Based Life Insurance Denials
There are a number of reasons why an insurance company might deny a claim for benefits under an employer-provided life insurance policy. One of the most common reasons is a mistake or omission on the application form. For example, if the employee failed to disclose relevant medical information when applying for life insurance coverage, the insurance company may claim that this omission invalidates the policy.
Another common reason for denial is that the insurance company might argue that the deceased employee did not meet the eligibility criteria set forth by the employer’s life insurance plan. This could include the employee’s failure to remain employed for the necessary duration, or the failure to enroll in the life insurance plan within the designated enrollment period.
Other reasons for denial include claims that the cause of death was not covered under the policy or that the claim was submitted too late. In these cases, the insurance company may point to specific policy provisions to justify the denial.
We contacted Trief & Olk to help us with a life insurance issue and Shelly Friedland was the attorney assigned to our case. Before Shelly took our case she explained to us that the likelihood of our success without going to court was possible but not likely. Unfortunately we did not get the outcome we had hoped for but it was our decision to not move forward and have our case litigated. Shelly is very knowledgeable and was very straight-forward in her assessment of our case as we moved forward. She was very patient and thorough in answering our questions. She always responded in a timely manner and listened to our concerns. We would certainly recommend Shelly and would use her firm again in the future.”
- John Ramig
If there is any possibility of winning your life insurance case – this is the place to do it for you. They are efficient, honest and will achieve the best possible outcome.
Shelly Friedland worked on my case where a life insurance policy had lapsed and was even a few days beyond the grace period. Farmers had rejected my claim twice and was unwilling to take a second look. Shelly was able to get them to pay the entire claim without going to court, and the full amount was deposited in my account within a couple months. Highest recommendation.”
- Kathleen Brown
Trief & Olk is a superior law firm. Their attorneys and other legal professionals have a brilliant understanding of the law and the litigation process. They diligently perform their work in an efficient, strategic and cost-effective manner to ensure the best possible outcomes for their clients.
- Christopher Hughes
What Should You Do If Your Claim Is Denied?
If you receive a denial for an ERISA-based life insurance claim, it’s critical to take prompt action. First, carefully review the denial letter to understand the exact reason your claim was rejected. The letter should outline the insurance company’s reasoning, and you may need to request additional documents or clarification to fully understand the basis of the denial.
Next, consider filing an appeal. Under ERISA, beneficiaries have the right to appeal a denied claim. However, it’s essential to note that the appeals process must be followed strictly, as failure to do so may result in the denial standing. The appeal should be submitted within a specific timeframe, typically 180 days from the date of the denial, but it’s important to check the specifics of your policy.
In preparing for an appeal, gather all relevant documents and evidence that support your claim. This may include medical records, proof of eligibility, or additional supporting documentation that could strengthen your case. It’s crucial to ensure that all of your documents are in order, as the appeals process is highly detailed and requires a comprehensive presentation of evidence.
How We Can Help You With Your ERISA Claim Appeal
The ERISA appeals process can be difficult to navigate without the proper legal guidance. As part of the process, the insurance company is required to conduct a full and fair review of your claim, but these companies often rely on legal technicalities or other tactics to deny claims. If you are not familiar with how to counter these tactics, your chances of success may be diminished.
Settlements & Verdicts
At this point, having an experienced attorney by your side can make a significant difference. We can assist in building a strong case for your appeal by reviewing all the details of your claim, identifying the reasons behind the denial, and working tirelessly to challenge those reasons. We are committed to ensuring that your appeal is as thorough and compelling as possible, giving you the best chance at a favorable outcome.
What to Expect During the ERISA Appeal Process
If you decide to move forward with an appeal, it is important to understand what to expect throughout the process. Once you submit your appeal, the insurance company is required to review your case and make a final decision within a specific timeframe, often 45 days. However, this period can be extended for an additional 45 days if the insurance company needs more time to review your claim.
During this time, you may be asked to provide additional information or clarification, so it’s crucial to stay organized and respond promptly to any requests from the insurance company. Once the review is complete, the insurer will issue a final decision on your appeal. If the claim is still denied, you may have the option of filing a lawsuit under ERISA to seek a judicial review of the decision.
Legal Options After an ERISA Appeal Denial
If your appeal is unsuccessful, the next step may be to file a lawsuit in federal court. ERISA claims are typically litigated in federal court, and the judge will review the case based on the administrative record created during the appeals process. At this stage, it is important to have experienced legal counsel who can help present your case effectively in court.
An ERISA lawsuit can be a lengthy and complex process, but it may offer the opportunity to overturn the denial and secure the benefits you deserve. The court may order the insurance company to pay the benefits or may require further action from the insurer. Additionally, it’s important to note that federal courts can award attorney fees in ERISA cases, which may provide some relief if your case is successful.
Why You Need a Lawyer for Your ERISA Claim Appeal
The process of challenging a denial of employment-based life insurance benefits under ERISA is not straightforward. Insurance companies often have significant resources at their disposal and can be aggressive in defending their position. This makes it all the more important to have a skilled attorney on your side who understands the ins and outs of ERISA law and can guide you through each stage of the process.
At Trief & Olk, we are committed to helping individuals like you navigate the complex ERISA claims process and fight for the benefits that are rightfully yours. Our team understands the challenges you face and is dedicated to advocating for your best interests every step of the way.
If you have been denied life insurance benefits under an employer-sponsored plan, don’t face the burden alone. Contact us today to schedule a consultation and let us help you secure the compensation you deserve. We are here to help you achieve the best possible outcome for your case.
