The Federal Employees’ Group Life Insurance (FEGLI) program provides important life insurance coverage for federal employees and their families. However, there are instances when beneficiaries receive the unexpected news that their FEGLI claim has been denied. This situation can feel overwhelming and upsetting, particularly after a loss. In these moments, understanding the denial process and learning how to challenge it can make a real difference. If you’re a New Jersey beneficiary dealing with a FEGLI denial, knowing your rights and the steps involved can empower you to take the appropriate actions to seek the benefits you are entitled to. At, Trief & Olk, we are here to guide you through the legal process and help you navigate the complexities of your case.
Understanding the Reasons Behind a FEGLI Denial
A FEGLI denial can occur for various reasons, and knowing the reasons behind the rejection can be the first step toward understanding your situation. Commonly, a denial may stem from issues related to incomplete or incorrect documentation, as the Office of Federal Employees’ Group Life Insurance (OFEGLI), which administers FEGLI claims, requires specific forms and information. Errors or omissions can easily lead to a denial. Other times, a denial might be based on eligibility issues if the insured individual did not meet certain requirements for coverage. These situations may involve policy lapses, such as when premiums were not paid on time, or eligibility discrepancies that may arise if the employee had reduced their coverage before passing away. Beneficiaries might also face denial if there is a contest about who should receive the benefits. Disputes often arise when there are changes in beneficiary designations or conflicting claims among family members. In cases where the policyholder designated multiple beneficiaries or updated their preferences, the process can become complicated, increasing the likelihood of a denial based on confusion or conflicting documentation. Learning the exact reason for the denial is essential to know how to proceed.
Steps to Contest a FEGLI Denial
If you are facing a FEGLI denial, the steps to contest it may seem complicated at first, but they are generally straightforward when broken down into clear actions. First, gather all relevant documentation. This may include the denial letter from OFEGLI, records of the policyholder’s employment history, pay stubs or statements that confirm premium payments, and any forms that were completed by the policyholder during their employment. Having a complete set of documents will help you address any missing information that may have led to the denial. Once you have organized your documents, the next step is to review the denial letter carefully. The denial letter should outline the reasons behind the decision, providing you with an understanding of what went wrong and what might be required for a successful appeal. Look closely at any specific points mentioned, such as missing documents or incorrect information, as addressing these issues directly can make a significant difference in your appeal. After reviewing the letter, it is time to consider filing an appeal. An appeal involves writing a formal letter to OFEGLI, explaining why you believe the denial should be reversed. This letter should include a detailed explanation that addresses the reasons for the denial and provides additional information if necessary. This part of the process may also involve filling out further forms and gathering supplementary records. Since this letter is the foundation of your appeal, take the time to review it thoroughly before submission to ensure it contains all necessary details.
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
Providing Additional Evidence to Support Your Case
If your FEGLI denial involved insufficient documentation, one of the most effective steps you can take is to gather and present additional evidence. Evidence can include employment records that verify the policyholder’s history and eligibility, pay stubs that demonstrate premium payments, and any documents the policyholder completed that might show their intent to maintain or update coverage. In some cases, medical records may also be relevant, especially if they clarify eligibility issues related to a health-related exclusion. Collecting these materials can be challenging, especially if you are working through multiple offices or departments to obtain them, but persistence is key. Providing OFEGLI with the fullest picture possible of the policyholder’s coverage can be instrumental in overturning a denial. When submitting new evidence, ensure that each document is properly labeled and explained in your appeal letter. Refer to the specific points of denial listed in the OFEGLI letter and highlight how each document addresses these issues. By being thorough and organized, you enhance the chances of a favorable review. While submitting additional evidence is often beneficial, it is also important to avoid sending unnecessary documents, as this may complicate the process and lead to additional delays.
Navigating Beneficiary Disputes
In some cases, FEGLI denials arise due to disputes among beneficiaries, especially if there were multiple named beneficiaries or recent changes to the policyholder’s beneficiary designations. Resolving disputes between beneficiaries can be complex, as OFEGLI must adhere to strict guidelines based on the policyholder’s designations and intent. If you are involved in a beneficiary dispute, obtaining legal guidance can be especially helpful. Legal professionals can assist in determining if the policyholder’s designations were clear, valid, and adhered to at the time of their passing. They can also help interpret any complicated legal issues that may arise, such as if a prior beneficiary disputes a change or if there is a question about the policyholder’s capacity to make decisions at the time of an update. Additionally, legal professionals can work on your behalf to gather statements from witnesses or acquire affidavits that may clarify the policyholder’s intent. When multiple beneficiaries are involved, mediation or negotiation may sometimes offer a path forward, allowing the parties to reach an agreement that benefits all involved. Mediation can provide a structured environment for discussing concerns and may even prevent the need for further legal proceedings. However, if mediation is unsuccessful, legal representation becomes crucial to ensuring that your case is presented effectively in any further proceedings.
20% The annual average number of life insurance claims denied. $50 Million The yearly average dollar amount of claims denied by life insurance companies. .2% The number of claims appealed annually by consumers.Life Insurance Denial Statistics
Working with OFEGLI During the Appeals Process
During the appeals process, maintaining open communication with OFEGLI can be beneficial. Reach out to an OFEGLI representative to confirm receipt of your appeal and request updates on the status of your case. OFEGLI processes claims and appeals through established procedures, but having a point of contact can make the process smoother and provide clarity on where your appeal stands. It is also essential to keep copies of all correspondence, including emails, letters, and any notes from phone conversations. Documenting your interactions can provide you with a record of your efforts and support your case if additional follow-ups are necessary. Keeping a timeline of these interactions can also be helpful for reference as you await updates.
Seeking Legal Assistance for Complex Cases
Contesting a FEGLI denial can be manageable for some beneficiaries, but for others, especially those facing complex denials or beneficiary disputes, legal assistance can be invaluable. Lawyers who are familiar with FEGLI policies and procedures can assess your case from a legal standpoint, providing advice on how best to proceed based on your unique circumstances. They can help review the denial reasons, draft a thorough appeal letter, gather additional evidence, and communicate with OFEGLI on your behalf. Attorneys can also provide insight into your rights as a beneficiary under New Jersey laws, helping you understand any state-specific regulations that might impact your case. Additionally, lawyers can identify potential obstacles in advance, such as issues with documentation or legal inconsistencies that might not be apparent to non-lawyers. Having a legal professional involved in your case can relieve some of the burdens and provide a clearer understanding of the process. Legal assistance is especially valuable in cases where OFEGLI’s initial denial decision may appear final or where additional challenges could require specialized knowledge of federal regulations.
Settlements & Verdicts
Considering the Appeals Timing and Deadlines
Appealing a FEGLI denial is a time-sensitive matter, as certain deadlines apply to the appeals process. Missing these deadlines can affect your ability to contest the denial, so it is important to be aware of all relevant dates from the outset. Review the denial letter for any specific time frames listed and make a note of them to ensure your appeal is submitted promptly. Preparing a complete appeal within the designated timeline requires a careful approach to avoid any last-minute issues or delays. Keeping track of deadlines is particularly important if you need to obtain additional records, as this process can sometimes be time-consuming. Planning your steps early on allows for a more organized appeal and provides you with ample time to resolve any unforeseen issues. If you feel pressed for time or are uncertain about the timing requirements, contacting a lawyer promptly can help you meet deadlines more effectively and avoid common timing mistakes.
The Importance of Persistence and Patience
Challenging a FEGLI denial requires persistence and patience, as the process can involve numerous steps and sometimes lengthy waiting periods. Keeping a positive mindset and staying organized throughout each stage will be beneficial. From gathering documents to drafting an appeal and waiting for a response, each stage of the process requires care and attention. It is also helpful to set realistic expectations for yourself. While many appeals are resolved favorably, outcomes depend on individual circumstances, including the strength of the evidence and the specific reasons for the denial. By remaining consistent and following through on each step, you increase the likelihood of a positive resolution.
If you are a beneficiary in New Jersey facing a FEGLI denial, seeking assistance can make a difference in your case. Trief & Olk is here to support you through the process, offering legal guidance tailored to your specific needs. Their experience in handling FEGLI cases means they can provide the insights and representation you may need to move forward with confidence. Reach out to Trief & Olk today to learn how they can help you pursue the benefits you deserve.