Understanding Employment-Based Life Insurance
Life insurance is a common benefit provided through many employers. These policies are generally offered at little to no cost to the employee, and often provide basic coverage with the option to purchase additional benefits. While these policies can be incredibly valuable, navigating them can be complex, particularly if a claim is denied. These policies are governed by the Employee Retirement Income Security Act (ERISA), which sets strict rules for employee benefit plans, including life insurance. ERISA ensures that employees are entitled to a fair process when disputing insurance claim denials, and it requires companies to adhere to certain procedures during the claims process.Common Reasons for a Denial
When a claim is denied, it’s often due to one of several common reasons. If the deceased individual did not have the required coverage, their beneficiaries might be denied benefits. Sometimes, the insurance company argues that the employee wasn’t eligible for the insurance coverage due to their employment status, such as if they had not been actively working at the time of their passing. If there were any mistakes in the paperwork or the claim was submitted incorrectly, the insurance company might deny the claim as well. Additionally, many life insurance policies have specific exclusions, such as suicide within the first two years or death due to illegal activities, which could also lead to a claim denial. In some cases, the insurance company might simply deny a claim due to insufficient documentation or information.
What to Do After a Denial
If your claim has been denied, the first thing to do is review the denial letter carefully. The insurance company is required to explain why the claim was rejected, and understanding their reasoning is key to deciding what to do next. If the claim was denied due to missing documentation or mistakes, you may be able to provide the necessary information and appeal the decision. If the denial was based on policy exclusions or eligibility requirements, it’s important to assess whether there’s room to dispute that reasoning. The next step is to file an appeal with the insurance company. ERISA requires insurers to have an appeals process in place, which usually involves submitting additional documents or clarifications regarding the claim. During this phase, you may need to provide more evidence or correct any mistakes that were made in the initial claim. It’s crucial to include all relevant information to support your case, such as proof that the policy was active, evidence that the coverage should apply in the given situation, or corrected paperwork if there were errors in the original submission.
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