ERISA Life Insurance Claim Denied and Appeal Process

If need help understanding why your ERISA life insurance claim was denied and the appeal process, contact John Peace at Peace Law Firm by calling 864-298-0500 today.

The death of a loved one is nothing short of devastating. And that hardship is made all the more difficult when you receive a rejection from your loved one’s employer after filing a life insurance claim. The Employee Retirement Income Security Act (ERISA) sets strict minimum standards for multiple types of employer-sponsored insurance programs. Life insurance plans are among the types of plans covered by ERISA. This means ERISA may give you options after a life insurance claim is denied. But taking a large company to federal court is a major step that requires careful planning and legal assistance. If your life insurance claim was denied, we recommend consulting with an experienced ERISA life insurance attorney right away. 

Preparing to File an ERISA Appeal After a Denial of Life Insurance

Before filing an ERISA appeal for a denied life insurance claim, you need to understand why the insurance company denied the claim. Life insurance companies do not make money when they grant insurance claims. Consequently, these companies will go to great lengths to find a reason to deny your claim. Many times, the reason behind the denial is an obscure part of the life insurance policy or a technicality. In any case, you need to understand the exact reason for the denial before starting the appeal process. Some of the most common reasons that insurance companies deny claims include the following:

ERISA Life Insurance Claim Denied and Appeal Process
  • Your claim included inaccurate or incomplete information. In general, only lies or omissions should result in a denial. A minor error about an insignificant fact, like a missing number in your address, should not lead to a denial. 
  • Your loved one died during the contestability period. The contestability period, which generally lasts about two years after the purchase of the policy, gives the company special rights to investigate your application. The insurance company may deny your claim if it finds there is missing or incomplete information in the life insurance application. 
  • The policy does not include your loved one’s cause of death. Life insurance policies often contain a long list of causes of death that are excluded from coverage. Common causes that a policy will not cover include death caused by a dangerous hobby, war, and suicide. 
  • You or your loved one failed to pay policy premiums. You or your loved one must be up-to-date on premium payments. Although many companies will tolerate late payments if they are less than 30 days late, longer periods will void your policy. 

Once you understand why the life insurance company denied your claim, you can start planning your ERISA appeal.

Other Pre-Appeal Steps

ERISA applies to virtually every insurance plan provided by a private-sector employer. However, there are a few exceptions. For instance, ERISA will not apply to a life insurance plan that is provided by a religious institution. Nor will it cover plans provided by government employers, including local, state, and federal governments. Before you file an appeal, make sure ERISA covers your loved one’s employer.

Filing an ERISA Appeal for Denial of Life Insurance

Once you have taken these preliminary steps, you can begin filing your ERISA appeal for denial of life insurance. Gather any evidence you have that supports your appeal. This may include a coroner’s report, hospital paperwork, or even a statement from an expert. Include all favorable evidence with your application. Your attorney can help you gather and present evidence to support your appeal claim. 

It is also critical that you pay attention to all applicable deadlines related to your appeal. While ERISA gives plaintiffs unique rights, it also demands they follow strict procedural rules. Most importantly, do not wait until after the applicable deadline to file your ERISA appeal. If your appeal is not timely, the court will throw out your claim and prohibit any future appeals. If your claim succeeds, you can receive the full amount provided by the life insurance policy. 

Need Legal Assistance with Your ERISA Life Insurance Claim?

Moving forward after your ERISA life insurance claim is denied is hard. Additionally, the appeal process is not easy to navigate without legal counsel. ERISA-related litigation is complex and has many unique requirements. Even a simple mistake can lead to you losing your appeal, leaving your financial future uncertain. 

The good news is that you do not have to jeopardize your financial future by filing an ERISA appeal on your own. Trust your future to John Peace and the Peace Law Firm. We have extensive experience with the ERISA process. Thanks to that experience, we have successfully appealed many ERISA denials and helped our clients put their lives back together after a tragedy. We offer free initial consultations for all potential clients. Give us a call or contact us online so that we can work together to get you the life insurance benefits you deserve.

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