When a denial is issued under the Federal Employees’ Group Life Insurance (FEGLI) program, it can feel confusing and overwhelming. FEGLI is an essential program providing life insurance benefits to federal employees, and the denial of a claim might leave beneficiaries facing financial uncertainty. Understanding how to navigate the legal process to appeal a FEGLI denial in New York is critical. This process is governed by federal rules, which are different from the laws governing private insurance claims. Learning the steps involved and knowing your rights can help you build a strong case for appeal. At, Trief & Olk, we are here to guide you through the legal process and help you navigate the complexities of your case.
What is FEGLI and Why Denials Happen
FEGLI is a life insurance program created for federal employees, retirees, and their families. It provides basic and optional life insurance coverage and is one of the largest group life insurance programs in the country. Claims under FEGLI are typically filed when a covered person passes away, allowing beneficiaries to receive the benefits. However, not all claims result in payment.
Denials may occur for several reasons, and understanding these reasons is the first step toward appealing. Common reasons for denial include incomplete paperwork, missed deadlines, disputes over coverage amounts, or questions about eligibility. In some cases, misunderstandings about policy provisions lead to denials. Beneficiaries may not realize that federal rules differ from state insurance laws, which can complicate the process. The appeal process exists to ensure that denials are reviewed fairly, but it requires careful attention to detail and adherence to strict guidelines.
Understanding the FEGLI Appeal Process
Appealing a FEGLI denial begins with requesting a reconsideration of the decision. This step involves providing additional information or correcting errors in the original claim. The Office of Federal Employees’ Group Life Insurance (OFEGLI), which administers FEGLI claims, handles this process. It is crucial to act quickly because strict deadlines apply to appeals. Missing these deadlines may result in losing the right to appeal.
During the reconsideration phase, you must submit evidence supporting your claim. This evidence may include documentation showing that the denial was based on incorrect or incomplete information. Examples include medical records, proof of eligibility, or copies of the policy. It is essential to present clear and compelling information that directly addresses the reasons for the denial. OFEGLI will review your submission and decide whether to reverse the denial or uphold it.
If the reconsideration process does not resolve the issue, you can take further legal action by filing a claim with the federal courts. This step is more complex and requires a detailed understanding of the law. Federal courts review FEGLI claims under the Federal Employees’ Group Life Insurance Act (FEGLIA), which sets the rules for how disputes are handled. Unlike private insurance claims, these cases are not subject to state laws, which means different procedures and standards apply.
Steps for Filing an Appeal in Federal Court
If your initial appeal with OFEGLI is unsuccessful, the next step is to file a claim in federal court. This process requires drafting a legal complaint, which is a document that explains why the denial was wrong and requests the court to reverse the decision. The complaint must include specific details about the policy, the claim, and the reasons for denial. It must also cite the federal laws and regulations that support your position.
Filing a federal court claim involves meeting deadlines and following court rules. Missing a deadline or failing to include required information can result in the case being dismissed. It is also important to be prepared for the legal challenges involved in federal court cases. OFEGLI will have legal representatives defending their decision, and you will need to present a strong and well-supported argument.
Federal court cases often involve gathering evidence, presenting witnesses, and making legal arguments. This process can take time, and the outcome depends on the strength of your case and the court’s interpretation of the law. It is essential to have a clear understanding of your rights and the steps involved to maximize your chances of success.
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
How Legal Representation Can Help with FEGLI Appeals
Navigating the FEGLI appeal process can be difficult without legal help. The rules governing these cases are different from those for private insurance claims, and understanding federal laws is crucial. Legal representation can make a significant difference in your case by ensuring that deadlines are met, evidence is properly presented, and arguments are made effectively.
An attorney can help you understand the reasons for the denial and identify the best approach for appealing. They can assist with gathering evidence, preparing documents, and representing you in court if necessary. This guidance can reduce the stress of the process and improve your chances of a favorable outcome.
Having an attorney also ensures that your rights are protected throughout the process. FEGLI claims involve complex legal issues, and an attorney can provide the knowledge and support needed to address these challenges. Whether you are appealing to OFEGLI or pursuing a federal court case, legal representation can be invaluable in achieving a successful resolution.
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
Important Deadlines to Keep in Mind
Timeliness is one of the most important factors in appealing a FEGLI denial. The appeal process has strict deadlines, and missing them can end your chances of reversing the denial. For example, requests for reconsideration must typically be submitted within 30 days of receiving the denial notice. Federal court claims also have deadlines, which vary depending on the specific circumstances of your case.
To meet these deadlines, it is essential to act quickly and stay organized. Keeping track of all correspondence, documents, and evidence related to the claim can help ensure that everything is submitted on time. Missing a deadline can be a costly mistake, so it is important to understand the timelines and plan accordingly.
What to Expect During the Appeal Process
The appeal process can take time, and patience is often required. OFEGLI may take weeks or months to review a reconsideration request, depending on the complexity of the case. Federal court cases can take even longer, as they involve multiple steps, including filing motions, gathering evidence, and attending hearings.
Throughout the process, communication is key. Staying informed about the status of your appeal and responding promptly to any requests for information can help keep the case moving forward. It is also important to remain focused on the goal of reversing the denial and obtaining the benefits you are entitled to receive.
Settlements & Verdicts
If you are facing a FEGLI denial, seeking help from a law firm can be an important step toward resolving the issue. The legal process for appealing these denials is complex, and having the right support can make a significant difference. A law firm with experience in handling FEGLI cases can provide the guidance and representation needed to navigate the process effectively.
Trief & Olk understands the challenges involved in appealing FEGLI denials in New York. Our team is committed to helping you through every step of the process, from understanding the reasons for the denial to presenting a strong case for appeal. Contact us today to discuss your case and learn how we can assist you in pursuing the benefits you deserve.