Understanding the Life Insurance Open Enrollment Period 
The open enrollment period is the designated time each year when employees can make changes to their benefits, including life insurance coverage. This is an important time, as it allows individuals to add, adjust, or remove life insurance policies based on changing circumstances or new needs. While open enrollment provides an opportunity to ensure your coverage matches your current situation, it can also lead to mistakes or misunderstandings that may result in a life insurance claim denial.
Life insurance policies often contain intricate details, and even a minor error in the enrollment process can create significant problems later on. Changes made during open enrollment might include altering the policy’s coverage amount, switching plans, or even updating beneficiary information. Unfortunately, if any of these changes are handled improperly or overlooked, it could cause complications in the future, especially when a claim is filed.
Why Open Enrollment Changes Can Lead to Life Insurance Claim Denials
When an open enrollment change goes wrong, the consequences may not be immediately clear, but they can cause serious issues later. A life insurance claim could be denied due to several factors, including:- Mistakes in Enrollment Forms: Open enrollment often involves submitting forms or making selections through a portal. If any of this paperwork is submitted incorrectly, missed, or misinterpreted, it could cause discrepancies in your coverage, leaving you without the protection you thought you had.
- Failure to Meet Policy Requirements: Some life insurance policies require certain criteria to be met, such as medical exams, specific beneficiary designations, or the submission of paperwork by a set deadline. If any of these conditions aren’t properly completed or if the paperwork is not processed on time, the policy may become invalid.
- Policy Lapse or Gaps in Coverage: If you missed a premium payment during open enrollment or your change in coverage wasn’t processed promptly, the insurer may consider your policy to have lapsed. A policy lapse can occur if premiums are missed or not paid by the deadline, and it may lead to the insurer denying a claim.
- Misrepresentation or Material Errors: If there are any discrepancies or material misrepresentations in the information provided during open enrollment—whether about your health history, lifestyle, or financial status—the insurer may use these issues to deny your life insurance claim.
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
Steps to Take When Your Life Insurance Claim is Denied
If your life insurance claim has been denied due to an open enrollment mistake, it’s important to take immediate action. Here are the essential steps to help you resolve the issue:Review the Denial Letter
The first thing you should do is carefully review the denial letter or communication from the insurance company. Insurance companies are required by law to provide a clear explanation for their decision, including details on the reason for the denial. These reasons could include missed premiums, incorrect beneficiary information, or failure to submit necessary documents during open enrollment. The denial letter will also outline your rights and options for challenging the decision. It may also contain specific instructions on how to request a review of the denial or how to file an appeal. Make sure to keep a copy of this letter for your records, as it will be essential for any future actions you take.Contact the Insurance Company for Clarification
Once you’ve thoroughly reviewed the denial letter, the next step is to contact the insurance company directly. Speak with a representative to get more information about why your claim was denied and to clarify any points in the letter that may be confusing. In many cases, a simple misunderstanding or mistake can be resolved quickly with a phone call. While speaking with the insurance company, ensure that you document the conversation. Keep detailed notes about who you spoke with, the date and time, and what was discussed. If the insurer provides any guidance or suggestions on how to correct the issue, make sure to follow these instructions promptly.Settlements & Verdicts
Gather Supporting Documentation
If the issue relates to a mistake in your open enrollment paperwork or if there is a question about missing payments or eligibility, gather all relevant documents that support your case. This could include:- Enrollment forms from the open enrollment period
- Payment records or bank statements showing premium payments
- Medical records, if applicable, especially if there was an issue with pre-existing conditions
- Any correspondence with the insurer regarding your life insurance policy
- Proof of eligibility for the life insurance policy
Appeal the Denial
If the insurance company maintains the denial after your initial inquiry, you have the right to appeal the decision. Most insurers have an internal appeals process, which can be initiated by submitting a formal letter or documentation that explains why you believe the denial was in error. Some states may also have additional protections for consumers, including the right to appeal a denial to a third-party arbitration or oversight body. Before beginning the appeal, review the insurer’s appeal instructions carefully. Ensure that you include all required documentation, and be clear and concise in your explanation of why you believe the claim should be paid out.Seek Legal Advice
If your appeal is unsuccessful, it may be time to consult with an attorney who specializes in life insurance claims. A lawyer can help you understand your legal rights, identify any potential violations of law, and guide you through the process of challenging the insurer’s decision. At this point, an attorney can also advise you on whether filing a lawsuit is the best course of action. If the insurer is acting in bad faith, such as intentionally denying a valid claim, you may have grounds for a lawsuit to force them to pay the benefits you are entitled to.How to Protect Your Life Insurance Coverage in the Future
Once you’ve addressed the current situation, it’s essential to take steps to protect your life insurance coverage moving forward. Here are a few tips for avoiding problems with your life insurance policy in the future:- Double-Check Your Paperwork: Each year during open enrollment, ensure that all of your life insurance selections and beneficiary information are correct. It’s important to carefully review all forms and confirm that they’ve been submitted accurately.
- Stay Up to Date on Premium Payments: Never miss a premium payment. Set up reminders or automatic payments to ensure that your policy remains active, even if you make changes to your coverage during open enrollment.
- Consult a Life Insurance Expert: If you’re unsure about any aspect of your life insurance policy, it’s a good idea to consult with an expert who can review your coverage and help ensure everything is in order.