Dealing with a denial of your Federal Employees’ Group Life Insurance (FEGLI) claim can be stressful and confusing. If you are a federal employee or a beneficiary of a FEGLI policy and your claim has been denied, it’s important to know that you have options. Understanding the appeal process and knowing what steps to take can help you overturn the denial and receive the benefits that are rightfully yours. If you live in New Jersey, this guide will walk you through the essential steps for successfully appealing a FEGLI claim denial. With patience and persistence, you can effectively navigate the process. At, Trief & Olk , we are here to guide you through the legal process and help you navigate the complexities of your case.
Understanding Why FEGLI Claims Are Denied
Before jumping into the appeal process, it’s important to understand why FEGLI claims may be denied in the first place. There are several common reasons for claim denials under the FEGLI program. One of the most frequent causes is incomplete or incorrect paperwork. Mistakes in forms, missing documents, or errors in the information provided can lead to an immediate denial. Other reasons for denial include policy lapses, where premiums were not paid on time, or situations where the death or disability occurred under circumstances not covered by the policy. Understanding the exact reason your claim was denied will be key when preparing for an appeal. Carefully review the denial letter, which should explain the specific reasons for the rejection of your claim.
Gathering the Necessary Documentation
Once you understand why your claim was denied, you need to gather all relevant documents to support your appeal. This includes any paperwork that was initially submitted with the claim, such as application forms, beneficiary information, and medical records. You may also need to provide additional evidence that was not included in the original submission. For example, if your claim was denied due to missing medical information, obtaining a detailed medical report from a doctor could strengthen your case. If the denial was due to a lapse in premium payments, showing proof of payments or explaining any extenuating circumstances could be helpful. The more documentation you can provide, the stronger your appeal will be. Be organized and thorough when collecting the necessary documents.
Filing a Request for Reconsideration
After gathering your documents, the next step is to file a request for reconsideration with the Office of Federal Employees’ Group Life Insurance (OFEGLI). This request is essentially your first formal step in the appeal process. It is important to follow the proper procedures and deadlines when filing for reconsideration. Generally, you will need to submit your request within 60 days of receiving the denial notice. Missing this deadline could result in the rejection of your appeal, so it is crucial to act quickly. In your request, clearly explain why you believe the claim was wrongfully denied. Provide a detailed explanation, supported by the documents you have gathered, to show why the denial should be reconsidered. Be respectful and factual in your appeal letter, and focus on providing evidence that contradicts the reasons for the denial.
The Role of an Administrative Review
If your request for reconsideration is denied, you have the right to seek further review. At this stage, your case may go through an administrative review process. This review is conducted by an administrative judge or hearing officer who will examine all of the evidence and documentation related to your case. During this phase, it is important to present your argument as clearly and thoroughly as possible. You may also want to consider hiring legal representation to assist you with the administrative review. A skilled attorney can help organize your evidence, prepare your case, and ensure that all legal requirements are met during the process. It is important to note that the administrative review process can take time, so patience and persistence are key.
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
The Importance of Timely Action
One of the most important factors in successfully appealing a FEGLI claim denial is taking timely action. There are strict deadlines in place for filing an appeal, and missing these deadlines can mean losing the chance to have your claim reconsidered. As mentioned earlier, the request for reconsideration must be filed within 60 days of the initial denial. If you miss this deadline, it can be very difficult to get your case reopened. Additionally, if you move forward with an administrative review, you must ensure that all required documents and forms are submitted within the specified time frame. Being prompt and organized throughout the appeal process is essential to avoid delays or further complications.
Seeking Legal Help for Your Appeal
While it is possible to handle a FEGLI claim denial appeal on your own, many individuals find the process to be complex and overwhelming. Navigating the legal and administrative steps involved can be difficult, especially if you are unfamiliar with the system. For this reason, many people choose to hire an attorney to help them with their appeal. A lawyer who has experience handling FEGLI claims can guide you through the process, help you understand your rights, and improve your chances of a successful appeal. They can assist with gathering evidence, filing paperwork, and representing you in administrative hearings if necessary. If you live in New Jersey and are facing a FEGLI claim denial, hiring an attorney can be a valuable step toward resolving the situation.
The Appeals Process Can Take Time
It is important to remember that the FEGLI appeals process can take time, and it is not uncommon for several months to pass before a final decision is made. Waiting for your appeal to be processed can be frustrating, but patience is necessary. During this time, it is essential to stay in communication with the OFEGLI and respond to any requests for additional information or documentation in a timely manner. If your case requires an administrative review, the process may take even longer. Staying organized, keeping track of deadlines, and following up with the necessary agencies will help ensure that your case moves forward as smoothly as possible. While it may take time, persistence can lead to a successful outcome.
Settlements & Verdicts
What to Do If Your Appeal Is Denied
If your appeal is denied at the administrative review stage, you may still have further options. In some cases, you may be able to take your case to court. However, this is a more complex and challenging process, and it is highly recommended that you seek legal representation if you choose to pursue litigation. A lawyer can help you determine whether you have a strong case for court and guide you through the legal process. While litigation is not always the best option, it can sometimes be the only way to obtain the benefits you are entitled to. If your claim is denied at the administrative level, it is important to weigh your options carefully and seek legal advice before making your next move.
Staying Calm and Focused During the Process
Dealing with a FEGLI claim denial can be stressful, but it is important to stay calm and focused throughout the process. Becoming overwhelmed or frustrated can make it harder to navigate the appeal process effectively. Take the time to understand the reasons for the denial, gather all necessary documentation, and carefully follow the required steps for filing an appeal. If you are unsure about any part of the process, seek help from a lawyer who can provide guidance. Staying organized, keeping a positive attitude, and maintaining patience will go a long way in helping you successfully appeal your FEGLI claim denial. Remember that the process takes time, but with the right approach, you can improve your chances of getting the benefits you deserve.
If you are struggling with a FEGLI claim denial in New Jersey, it’s important to know that you don’t have to go through the process alone. The legal team at Trief & Olk is here to help you with every step of the appeal process. Our dedicated attorneys have the knowledge and experience to guide you through the complexities of FEGLI claims and ensure that your case is handled with care. Don’t wait to get the help you need. Contact Trief & Olk today for a consultation and let us help you get the benefits you deserve.