Denied ERISA Life Insurance Claims

If your employer-provided life insurance claim was denied, ERISA law likely governs your case. ERISA (the Employee Retirement Income Security Act) sets complex rules for how group life insurance claims must be handled, appealed, and litigated. At Lassen Law Firm, we focus exclusively on helping beneficiaries challenge denied life insurance claims nationwide, including those controlled by ERISA. Christian Lassen, Esq., a life insurance attorney with over 20 years of experience, personally handles every case to ensure skilled representation.

If a life insurance claim governed by ERISA is denied, the beneficiary must first exhaust the plan’s administrative appeal process before filing a lawsuit. Strict deadlines apply, and acting quickly is critical to protect your rights.

What Is ERISA and How It Affects Life Insurance Claims

ERISA is a federal law that governs employee benefits, including group life insurance policies offered through work. When a claim is denied under an ERISA-governed policy, beneficiaries must follow a specific appeal process laid out in the plan documents before they can sue. ERISA also impacts what damages can be recovered — typically limiting recovery to the policy benefits, plus possibly attorney’s fees and interest.

Unlike private life insurance claims, ERISA claims are handled primarily through federal courts, and special rules about evidence and deadlines apply.

Why ERISA Life Insurance Claims Get Denied

Insurance companies and employers deny ERISA life insurance claims for many reasons. Common grounds include alleged policy lapses after termination of employment, failure to properly convert coverage after leaving a job, disputes over beneficiary designations, and alleged misrepresentations.

Unfortunately, many ERISA life insurance claim denials happen because employers mishandle paperwork, fail to provide required notices, or make administrative errors — and insurers deny based on those errors.

How We Help With Denied ERISA Claims

At Lassen Law Firm, we understand ERISA’s complex rules and aggressively fight denials. We obtain the full administrative record, prepare detailed appeals within the strict ERISA deadlines, and, if necessary, file federal lawsuits to enforce payment of the life insurance benefits. Our firm is skilled at identifying when insurers or employers violate ERISA duties — and using that to overturn denials.

For example, we recently helped a spouse recover $300,000 after an employer failed to provide proper notice of conversion rights at termination. The insurer denied the claim, but we successfully appealed under ERISA and obtained full benefits.

Common Reasons for ERISA Life Insurance Denials

• Failure to timely convert group coverage after leaving employment

• Alleged lapse due to employer error

• Misrepresentation on insurance applications

• Beneficiary disputes after divorce or employment changes

• Delay in submitting proof of loss

• Failure to designate a new beneficiary after marriage or divorce

• Contestability investigations during initial two years of coverage

• Deaths ruled outside policy terms

• Exclusions for certain causes of death applied improperly

• Late premium payments by employers causing lapse

What to Do After a Denied ERISA Life Insurance Claim

If your ERISA life insurance claim is denied:

1. Request the denial letter and plan documents in writing immediately.

2. Review the insurer’s stated reasons for denial carefully.

3. Do not submit an appeal yourself without legal guidance.

4. Contact an experienced ERISA life insurance attorney immediately.

5. File an administrative appeal within the ERISA deadline (usually 180 days).

Acting within ERISA’s strict timelines is crucial — missing deadlines can destroy your claim.

Frequently Asked Questions About Denied ERISA Life Insurance Claims

What makes an ERISA life insurance claim different?

ERISA claims require beneficiaries to exhaust administrative appeals before suing and are governed by federal court procedures and remedies.

How long do I have to appeal a denied ERISA life insurance claim?

Typically, you have 180 days from the date of denial to submit an administrative appeal under ERISA regulations.

Can I sue immediately after denial?

No. Under ERISA, you must first exhaust the internal appeal process before filing a lawsuit.

What happens if I miss the appeal deadline?

Missing the ERISA appeal deadline usually means you lose your right to sue or recover benefits.

Who do I sue in an ERISA life insurance case?

Typically, you sue the insurance company, not your employer, although in some cases employers can be liable for administrative errors.

Can ERISA life insurance claims recover bad faith damages?

No. Under ERISA, beneficiaries generally cannot recover punitive damages — only plan benefits, interest, attorney’s fees, and possibly equitable relief.

What is the administrative record in an ERISA case?

The administrative record includes all documents the insurer reviewed to make the decision. Courts usually limit review to this record in lawsuits.

Can I submit new evidence during a lawsuit?

Usually not. New evidence is rarely allowed in ERISA lawsuits unless special exceptions apply, making the appeal stage critical.

Can I negotiate a settlement during the appeal process?

Yes. Skilled attorneys often negotiate settlements while preparing ERISA appeals, leveraging the insurer's risk of losing later in court.

What if the insurer claims the employee was no longer covered?

You can challenge wrongful denials based on employer error, improper notice of conversion, or misapplication of plan terms.

Does divorce impact ERISA life insurance benefits?

Yes. Divorce can revoke prior beneficiary designations under some state laws, although ERISA preemption rules complicate these cases.

Are group accidental death claims under ERISA too?

Yes. If accidental death coverage is employer-provided, it falls under ERISA's rules and appeal procedures.

Can late premium payments cause denial under ERISA policies?

Yes. If the employer fails to forward premiums properly, insurers may deny claims, but legal challenges may still succeed.

Does the contestability period apply to group ERISA policies?

Yes. Insurers may investigate applications during the first two years, but still must act fairly and reasonably.

What should I do if the employer gave wrong information about coverage?

You may have legal claims against the employer under ERISA if misinformation caused loss of life insurance benefits.

Can I recover attorney’s fees if I win my ERISA lawsuit?

Yes. Courts often award reasonable attorney’s fees to successful ERISA plaintiffs.

How long does an ERISA life insurance lawsuit take?

Most cases resolve within 6 to 18 months, depending on court schedules and settlement opportunities.

Will my ERISA life insurance lawsuit be decided by a jury?

No. ERISA life insurance lawsuits are typically decided by a judge, not a jury.

How can a lawyer help with a denied ERISA life insurance claim?

An attorney helps by preparing the appeal correctly, preserving evidence for court, negotiating settlements, and litigating skillfully if necessary.