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.Life Insurance Denial Statistics
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.