Facing a denial of Federal Employees’ Group Life Insurance (FEGLI) benefits can be an overwhelming experience for beneficiaries. The FEGLI program is designed to provide financial security for federal employees and their families, but in some cases, beneficiaries encounter unexpected denials when filing claims. Understanding the common reasons for FEGLI denials and the potential solutions can help beneficiaries navigate this process and ultimately secure the benefits they 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.
What Is FEGLI and How Does It Work?
FEGLI is a life insurance program available to federal employees, providing basic life insurance coverage as well as optional coverage for employees, their spouses, and their children. The program was established to ensure that federal employees and their loved ones have financial protection in the event of the employee’s death. However, as with any insurance policy, the process of filing a claim and receiving benefits can sometimes be more complex than expected.
When a federal employee passes away, their beneficiaries are entitled to receive the death benefits outlined in the FEGLI policy. But in some cases, beneficiaries find themselves facing a denial when they try to claim the benefits. This can be a stressful situation, especially when the denial seems unexpected or unclear.
Common Causes of FEGLI Denials in New Jersey
There are several reasons why a FEGLI claim might be denied in New Jersey. Understanding these common causes can help beneficiaries better prepare for the claims process and address any potential issues that may arise. One of the most common reasons for a denial is incomplete or incorrect paperwork. Filing a claim requires a significant amount of documentation, including proof of the policyholder’s death, proof of the beneficiary’s identity, and other relevant information. If any of this paperwork is missing or contains errors, the claim may be denied.
Another common reason for denial is a lapse in the policy. FEGLI coverage is not automatic; it requires regular payments from the policyholder to maintain the coverage. If the policyholder failed to make the required payments or if the coverage lapsed for any reason, the beneficiary’s claim may be denied.
Disputes over beneficiary designation can also lead to a denial. In some cases, there may be confusion or disagreement over who is the rightful beneficiary of the policy. This can happen if the policyholder failed to update their beneficiary information after major life events such as marriage, divorce, or the birth of a child. If the policy’s listed beneficiary conflicts with current circumstances, the insurance company may deny the claim until the dispute is resolved.
Finally, there may be issues related to the policyholder’s employment status at the time of their death. FEGLI coverage is tied to the policyholder’s status as a federal employee. If the policyholder was no longer employed by the federal government at the time of their death, or if they had retired and failed to convert their coverage, the claim may be denied.
Solutions for Beneficiaries Facing FEGLI Denials
If you are a beneficiary who has received a denial letter for a FEGLI claim, it is important not to panic. There are several steps you can take to resolve the issue and potentially secure the benefits you are entitled to. The first step is to carefully review the denial letter. The letter should provide a detailed explanation of the reason for the denial, which can help you determine the next course of action.
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
If the denial was due to missing or incorrect paperwork, the solution may be as simple as providing the necessary documents or correcting any errors. In this case, it is important to gather all of the required documentation and resubmit the claim as quickly as possible.
If the denial was based on a lapse in the policy or an issue with payments, you may need to investigate the circumstances surrounding the lapse. In some cases, there may be a valid reason why the policyholder failed to make the required payments, such as a medical condition or other extenuating circumstances. If you believe that the lapse was due to an error or an unavoidable situation, you may be able to appeal the denial and argue for the reinstatement of the coverage.
For beneficiaries facing a dispute over beneficiary designation, it is important to gather any evidence that supports your claim to the benefits. This may include documentation of the policyholder’s intentions, such as a will or other legal documents, as well as testimony from witnesses who can verify the policyholder’s wishes. Resolving a beneficiary dispute can be a complex process, but it is possible to reach a resolution with the help of legal guidance.
Finally, if the denial is related to the policyholder’s employment status, it may be necessary to review the policyholder’s employment records and confirm their eligibility for coverage at the time of their death. In some cases, retirees may have failed to convert their coverage or may have overlooked important steps in maintaining their benefits. If this is the case, there may be options for appealing the denial or seeking alternative sources of benefits.
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
The Appeals Process for FEGLI Denials
Appealing a FEGLI denial can be a time-consuming and complicated process, but it is often the best way to secure the benefits you deserve. The first step in the appeals process is to gather all of the relevant documentation, including the denial letter, the original claim, and any supporting documents that may help your case. You will also need to provide a written explanation of why you believe the denial was incorrect and what evidence you have to support your appeal.
Once you have gathered all of the necessary information, you will need to submit your appeal to the Office of Personnel Management (OPM), which oversees the FEGLI program. The OPM will review your appeal and make a decision based on the information you have provided. In some cases, the OPM may request additional information or documentation before making a decision.
If your appeal is successful, the OPM will overturn the denial and authorize the payment of benefits. However, if your appeal is denied, you may have the option to pursue further legal action, such as filing a lawsuit against the insurance company. This can be a lengthy and complex process, but it may be necessary to secure the benefits you are entitled to.
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Why Legal Guidance Is Essential for FEGLI Denials
Navigating a FEGLI denial can be an overwhelming and emotionally challenging experience for beneficiaries. The process of filing a claim, appealing a denial, and securing benefits often requires a deep understanding of the insurance system, as well as knowledge of federal employment laws and regulations. For this reason, many beneficiaries choose to seek legal guidance when dealing with a FEGLI denial.
A law firm that has experience in handling FEGLI denial cases can provide invaluable support throughout the process. From helping you gather the necessary documentation to guiding you through the appeals process and representing you in court if necessary, a legal team can make a significant difference in the outcome of your case.
When selecting a law firm, it is important to choose a team that has a proven track record of success in handling FEGLI denial cases. This can provide you with the confidence that your case is in capable hands and that you have the best possible chance of securing the benefits you deserve.
If you are a beneficiary in New Jersey facing a FEGLI denial, the team at Trief & Olk is here to help. With years of experience in handling complex insurance denial cases, we understand the challenges you are facing and are committed to providing the support and guidance you need. Our team will work tirelessly to investigate the cause of your denial, gather the necessary evidence, and advocate on your behalf throughout the appeals process.
Don’t let a denial prevent you from receiving the benefits you are entitled to. Contact Trief & Olk today to learn more about how we can assist you with your FEGLI denial case. Our dedicated team is ready to provide you with the legal support you need to navigate this difficult process and secure the financial protection your loved one intended for you. To get in touch with us, you can call or email our office, and we will be happy to discuss your case and help you take the next steps forward.