If you are a beneficiary of a federal employee who had Federal Employees Group Life Insurance (FEGLI) and you are facing a claim denial, you might be feeling confused, frustrated, and unsure of where to turn next. The good news is that you don’t have to navigate this complex process on your own. At times like this, it is important to have someone who understands the ins and outs of the law and can guide you through the steps toward contesting a denied claim. Here, we want to give you the information and support you need to understand your options and take the next steps in fighting for the benefits you are rightfully owed.
Understanding the FEGLI Program
Before diving into the contesting process, it is essential to understand what the FEGLI program is and how it works. The FEGLI program is a life insurance benefit offered to federal employees. This coverage is designed to provide financial support to beneficiaries in the event of the policyholder’s death. However, there are times when claims under this program are denied, leaving beneficiaries with the difficult task of trying to recover the benefits.
Reasons Why a FEGLI Claim May Be Denied
There are several reasons why a claim under the FEGLI program might be denied. In many cases, the denial is the result of issues that could have been avoided or contested. One common reason is the failure to meet the requirements for coverage. For instance, the policyholder may have missed a required premium payment or failed to properly designate a beneficiary. Additionally, some denials occur because the insurance company claims that the death was not caused by a covered event, such as a suicide within the first two years of coverage or a pre-existing condition.
Another reason for a denial can be related to technicalities in the documentation. The paperwork submitted by the beneficiary may be incomplete, incorrect, or not properly filed. It is not uncommon for insurance companies to challenge claims based on seemingly minor mistakes. This is where the process of contesting the denial becomes important.
The Process of Contesting a Denied FEGLI Claim
If you have been notified that your FEGLI claim has been denied, you may wonder what steps to take next. The first thing to do is carefully review the denial notice. The insurance company is required to provide a reason for the denial, and understanding their rationale is the key to determining the best way to proceed. It is important to thoroughly examine the explanation to see if the denial is based on a misunderstanding or an error.
Once you understand the reason for the denial, you can begin the process of challenging it. This may involve gathering additional evidence or documentation that supports your claim. If the insurance company cites incomplete forms or incorrect paperwork as the reason for the denial, it may be possible to resolve the issue by submitting the corrected forms or other required documents. If the denial is based on a more complex issue, such as the interpretation of the policy or the determination of cause of death, a more in-depth legal challenge may be necessary.
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
In some cases, you may be able to resolve the dispute through direct negotiation with the insurance company. However, if this proves unsuccessful, you may need to file an appeal. Appealing a denied claim involves presenting your case to a higher authority within the insurance company or to a third-party reviewer who can reconsider the decision. It is crucial to have an experienced attorney by your side during this stage to ensure that the appeal is handled properly and all relevant evidence is presented.
Legal Grounds for Contesting a FEGLI Denial
When contesting a denied FEGLI claim, there are several legal grounds that may be used to challenge the denial. These grounds include errors in the application process, failure to provide adequate notice of policy terms, or improper interpretation of the insurance policy by the insurer. One legal approach is to demonstrate that the insurance company misunderstood the facts surrounding the claim or misapplied the terms of the policy.
Another legal avenue is to argue that the insurance company acted in bad faith. If you believe that the insurer intentionally denied your claim without a valid reason, it may be possible to file a lawsuit based on bad faith insurance practices. In these cases, the insurer may be held liable for not acting in good faith and could face penalties, including the payment of damages beyond the original claim.
Settlements & Verdicts
Filing a lawsuit is often a last resort when other attempts to resolve the dispute have been unsuccessful. This legal process can be complex, and it is critical to have a knowledgeable attorney to represent your interests and ensure the best possible outcome.
How an Attorney Can Help
Navigating the process of contesting a denied FEGLI claim can be overwhelming. The legal issues involved can be complicated, and the insurance companies may try to deny your claim on technicalities or misunderstandings. This is where having an experienced attorney on your side can make all the difference.
An attorney specializing in insurance claims can assist you in many ways. They can help you understand the denial notice, gather the necessary documentation, and craft a strong case for contesting the denial. If needed, an attorney can represent you during the appeals process and, if necessary, help you pursue a lawsuit. In many cases, having legal representation increases the likelihood of a favorable outcome and can save you time and stress.
Moreover, an attorney can provide the emotional support and understanding that you need during this difficult time. Losing a loved one is hard enough, and dealing with the added stress of a denied claim can be overwhelming. With a legal professional by your side, you can focus on what matters most while they handle the complexities of your case.
If your FEGLI claim has been denied, it is important to remember that you do not have to face this challenge alone. Understanding the reasons for the denial, gathering the necessary evidence, and exploring your legal options are all crucial steps in the process. With the right legal representation, you can fight for the benefits you are entitled to and ensure that your loved one’s policy is honored.
At Trief & Olk, we understand how frustrating and confusing it can be to face a denied FEGLI claim, especially when you are already dealing with the loss of a loved one. Our experienced team is dedicated to helping beneficiaries like you navigate the complexities of insurance claims and pursue the benefits that are rightfully owed. We are here to help you every step of the way and fight for the justice you deserve. Reach out to us today to discuss your case and begin the process of contesting a denied FEGLI claim.
