Understanding Your Rights: Legal Options for Denied Employment-Based Life Insurance Claims

At our law firm, we understand that dealing with the denial of an employment-based life insurance claim can be an incredibly stressful and overwhelming experience. When you lose a loved one, the last thing you expect is to encounter challenges in receiving the benefits that were meant to provide financial security. If you are facing this situation, know that you are not alone. We are here to guide you through the complexities of these claims and help you pursue the outcome you deserve.

Understanding Employment-Based Life Insurance Claims

Employment-based life insurance is often included as part of a benefits package offered by employers. These policies are designed to provide financial support to the loved ones of an employee in the event of their passing. While these plans are intended to bring peace of mind, disputes can arise when claims are denied, leaving beneficiaries in a difficult position.

There are many reasons why a claim may be denied. Some of the most common include administrative errors, lapses in coverage, allegations of misrepresentation on the application, or disputes over the cause of death. Regardless of the reason for denial, beneficiaries should not lose hope. With the right legal guidance, there is often a path to resolve these disputes and secure the benefits that are rightfully owed.

Why Life Insurance Claims Are Denied

Life insurance companies have a duty to investigate claims thoroughly before making a decision. However, this process does not always go smoothly. Insurance providers may deny claims due to policy exclusions, such as deaths resulting from specific circumstances like suicide within a certain period after obtaining the policy. Administrative mistakes, such as improper documentation or missed premium payments, can also lead to denials.

In some cases, insurers may claim that the policyholder provided inaccurate or incomplete information when applying for the insurance. Even minor errors on an application can be used as grounds for denial. Beneficiaries may also encounter challenges if the employer failed to handle enrollment or premium payments correctly, leaving the policy inactive at the time of the policyholder’s death.

Ted Treif (Partner)

Life insurance attorney since 1976

Barbara Olk (Retired)

Life insurance attorney since 1976

Eyal Dror (Associate)

Life Insurance Attorney since 2007

Legal Options for Beneficiaries Facing Denials

If your claim has been denied, it is essential to remember that you have rights. Life insurance policies are legally binding contracts, and insurers are required to act in good faith when handling claims. When an insurer denies a claim without valid justification or fails to conduct a proper investigation, beneficiaries may have legal recourse.

One of the first steps in challenging a denial is to obtain a clear understanding of the reasons provided by the insurance company. Reviewing the denial letter and the terms of the policy can provide valuable insight into the dispute. This is often the foundation for determining the best course of action moving forward.

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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.

- Christopher Hughes

Filing an Appeal with the Insurance Company

Many life insurance policies include provisions for appealing a denied claim. This process allows beneficiaries to present additional information or evidence that supports their case. For example, if the denial was based on allegations of misrepresentation, providing accurate records and documentation can help refute the insurer’s claims.

While appealing directly to the insurance company can sometimes resolve the issue, it is not always successful. Insurance providers are motivated to minimize payouts, which can lead to unfair practices or resistance to reconsidering their decision. If an appeal does not yield the desired result, further legal action may be necessary.

Pursuing a Lawsuit for Denied Benefits

In cases where appeals are unsuccessful, filing a lawsuit may be the best option. Legal action can compel the insurer to provide a thorough review of the claim and may result in the recovery of benefits. These cases often involve a detailed examination of the policy terms, the circumstances surrounding the denial, and the actions of the insurance company.

Taking legal action can be a daunting process for beneficiaries, especially during an already difficult time. However, having skilled legal representation can make all the difference. An attorney experienced in life insurance claims can build a strong case by gathering evidence, negotiating with the insurance company, and advocating for your rights in court if necessary.

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$1.5 Million Policy

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The Importance of Acting Quickly

When dealing with a denied life insurance claim, time is a critical factor. Policies often have strict deadlines for filing appeals or taking legal action. Waiting too long to address the issue could result in losing the opportunity to recover benefits. Consulting with an attorney early in the process ensures that all deadlines are met and that your rights are protected.

In addition to adhering to time limits, taking prompt action allows for a more thorough investigation of the claim. Gathering evidence, obtaining witness statements, and reviewing policy documents are all time-sensitive tasks that can strengthen your case.

Overcoming Challenges with Employment-Based Policies

Employment-based life insurance claims often involve unique challenges that can make the process more complicated than individual policies. These plans are typically governed by federal regulations such as the Employee Retirement Income Security Act. This law sets specific rules for how benefits are managed and disputes are resolved. While these protections are intended to safeguard employees and their families, navigating the legal framework can be intimidating without proper guidance.

Disputes can also arise due to discrepancies between the employer and the insurer. For example, an employer may fail to remit premiums or mishandle enrollment documentation, leading to questions about whether the policy was in effect. Beneficiaries should not be penalized for errors beyond their control. Having legal representation ensures that all responsible parties are held accountable and that the full circumstances are thoroughly examined.

If you are facing the denial of an employment-based life insurance claim, it is understandable to feel overwhelmed and uncertain about what to do next. At Trief & Olk, we are committed to providing compassionate and effective legal representation to help beneficiaries secure the benefits they deserve.

Our team has extensive experience handling life insurance disputes and is dedicated to guiding clients through every step of the process. Whether you are in the initial stages of filing an appeal or considering legal action, we can provide the support and advocacy you need to achieve a successful resolution.

Contact us today to discuss your case and learn more about how we can assist you. At Trief & Olk, we are here to help you navigate this challenging time and work toward the outcome you and your family deserve.

To learn more about this subject click here: Overcoming Denied Life Insurance Claims in New Jersey: Effective Legal Strategies