Steps New York Beneficiaries Can Take After a FEGLI Claim Denial

If you are reading this, it means you or a loved one may have recently encountered the distressing experience of having a FEGLI (Federal Employees Group Life Insurance) claim denied. At times like these, the process can feel overwhelming and frustrating. You might have questions like why your claim was denied and what steps you can take next. Rest assured that you are not alone in this situation. We understand that navigating this challenging time can bring up feelings of confusion and worry. This is where legal help can provide clarity and support to help you resolve your claim in a successful way.

Understanding Why a FEGLI Claim Can Be Denied

First and foremost, it’s important to understand why a FEGLI claim might be denied. There are several reasons why an insurance provider might reject a claim, such as incomplete paperwork, issues with the policyholder’s coverage, or even technicalities related to eligibility. Each situation is different, and the reasons for denial are not always clear. For instance, a claim could be denied if the deceased did not have active coverage at the time of their passing, or if the beneficiary failed to provide required documentation. In some cases, the insurance company might claim that the beneficiary is ineligible or that the policyholder failed to keep their premiums up to date.

A denial can feel like a roadblock, but it is essential to remember that just because a claim has been denied, it does not mean the process is over. There are still options available for beneficiaries to appeal the decision and seek the compensation they deserve.

What Should You Do When Your FEGLI Claim Is Denied

Receiving a denial letter from the FEGLI program can cause confusion. You might be asking yourself how to respond and what actions need to be taken next. The first thing to remember is that the denial is not necessarily the end of the road. It is simply a starting point for the next steps, which involve evaluating the reasons for denial and deciding how to proceed.

The first action you should take is carefully reviewing the denial letter. Insurance companies are required to provide an explanation for their decision. This explanation will typically highlight the specific reasons why your claim was denied. Take note of any discrepancies or errors that might have led to the denial. A claim can sometimes be denied due to a simple mistake, such as missing paperwork or a clerical error. Understanding why the claim was denied is a crucial step toward determining your next move.

Ted Treif (Partner)

Life insurance attorney since 1976

Barbara Olk (Retired)

Life insurance attorney since 1976

Eyal Dror (Associate)

Life Insurance Attorney since 2007

Appealing a Denied FEGLI Claim

Once you have reviewed the denial letter and understand the reasons for the rejection, you may want to consider filing an appeal. The appeal process allows you to challenge the decision made by the insurance company. This is an important step in making sure you have every opportunity to present your case.

When you begin the appeal process, it is crucial to gather all relevant information. This may include documents such as the policyholder’s death certificate, proof of insurance coverage, and any other supporting evidence that could strengthen your claim. It is also important to address the reasons provided in the denial letter and provide any new information or clarifications that may not have been previously considered. In some cases, the insurance company may require additional documentation or information from you in order to process your appeal.

In many cases, it is helpful to work with an attorney who is experienced in handling denied FEGLI claims. Legal counsel can guide you through the appeal process and help you organize the necessary documents. If you decide to file an appeal, make sure to do so within the time frame specified by the insurance company. Missing deadlines can lead to the loss of your right to appeal.

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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

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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

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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.

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Seeking Legal Assistance for a Denied FEGLI Claim

If you are feeling overwhelmed by the appeals process, you may want to consider seeking the assistance of an attorney. A legal professional with experience in handling denied FEGLI claims can provide you with valuable insights and assistance. An attorney can help you understand the complex language in the denial letter and assess whether the insurance company’s decision is based on a valid reason.

Additionally, a lawyer can help you collect and present the necessary documents and evidence to strengthen your case. Legal counsel can also assist in negotiating with the insurance company to achieve the best possible outcome. Having someone who knows the ins and outs of the claims process can make all the difference in whether your claim is successful.

Common Reasons for a FEGLI Claim Denial in New York

There are a variety of reasons why a FEGLI claim might be denied. Some of the most common reasons include administrative errors, discrepancies in the information provided, and issues with the policyholder’s eligibility. For instance, if the policyholder was not actively enrolled in FEGLI at the time of their death, the claim may be denied. Similarly, if the beneficiary failed to provide the necessary documentation or if the policyholder had not kept up with premium payments, the claim may not be approved.

Life Insurance Denial Statistics

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.

While these reasons might seem like they leave little room for recourse, they often present opportunities to rectify the situation through an appeal. For example, if the denial was due to incomplete paperwork, you may be able to submit the missing documents. If the issue was related to eligibility, you might be able to prove that the policyholder was indeed eligible for coverage.

Taking Legal Action If Your Appeal Is Denied

If your appeal is unsuccessful, there are still options available. In some cases, you may need to take legal action to resolve your claim. This could involve filing a lawsuit against the insurance company or seeking other legal remedies. Taking legal action can be a lengthy and complicated process, but it may be necessary to ensure that you receive the compensation to which you are entitled.

Settlements & Verdicts

$3 Million Policy

William Penn Life Insurance

$1.2 Million Policy

Primerica

$1.5 Million Policy

Metropolitan Life Insurance Company

$1 Million Policy

Protective Life Insurance

$675,000 Settlement

Confidential Settlement

$4.3 Million Policy

State Farm, Primerica, Farmers, BrightHouse

It’s important to note that lawsuits regarding denied FEGLI claims are subject to specific rules and timelines. Therefore, it’s crucial to consult with an attorney who can help you navigate the legal system and determine the best course of action for your case. With the right legal help, you can increase your chances of securing a favorable outcome.

At Trief & Olk, we understand how difficult it can be to deal with a denied FEGLI claim. We know that the emotional toll of losing a loved one is already heavy enough, and the added stress of a denied claim can be overwhelming. That’s why we are here to help guide you through this process and fight for the benefits that you deserve. Our team is committed to working on your behalf, reviewing your case, and helping you take the necessary steps to secure the compensation you are entitled to.

If you are facing a denied FEGLI claim in New York, don’t hesitate to reach out to us. We are here to support you and help you navigate the complexities of the insurance claims process. Let us help you achieve the best possible outcome for your case.

To learn more about this subject click here: Massachusetts Beneficiaries: Essential Legal Insights on Navigating FEGLI Claim Denials