Why Was My ERISA Life Insurance Claim Denied?
ERISA governed life insurance claims are commonly denied because the plan administrator claims that coverage requirements, documentation rules, or procedural deadlines were not satisfied. Unlike individual life insurance policies, ERISA claims are controlled by strict federal rules that often have nothing to do with whether the beneficiary reasonably expected coverage.
A denial does not mean the claim is over. Many ERISA life insurance denials can be appealed and overturned when handled correctly.
What Makes ERISA Life Insurance Claims Different
ERISA applies to most employer sponsored group life insurance plans. These claims follow a federal framework that controls:
• How claims are reviewed
• What evidence may be considered
• When appeals must be filed
• Whether a lawsuit is allowed
Because of these rules, errors early in the process can permanently affect the outcome.
Common Reasons ERISA Life Insurance Claims Are Denied
Plan administrators frequently deny ERISA life insurance claims based on technical or administrative grounds, including:
• Alleged failure to submit required documentation
• Missed claim or appeal deadlines
• Disputes over beneficiary designations
• Alleged lapse or termination of coverage
• Failure to convert group coverage after employment ends
• Interpretation of plan exclusions
• Conflicts between plan documents and employer records
Many denials are based on paperwork issues rather than the merits of the claim.
Beneficiary and Enrollment Related Denials
ERISA denials often involve beneficiary or enrollment problems, such as:
• Outdated beneficiary designation forms
• Inconsistent enrollment or payroll records
• Coverage elections recorded incorrectly
• Employer administrative errors
Under ERISA, the plan documents often control, even when the result appears unfair.
Coverage Termination and Conversion Issues
A common ERISA denial occurs after employment ends. Insurers may claim that coverage lapsed or that the employee failed to convert group coverage to an individual policy.
These denials frequently involve notice failures, employer mistakes, or misunderstandings about conversion rights and are often challengeable under ERISA.
The Importance of the Administrative Appeal
ERISA requires beneficiaries to complete the administrative appeal process before filing a lawsuit.
This appeal is critical because:
• It is often the final opportunity to submit evidence
• Courts typically review only the administrative record
• New documents may not be allowed later
A weak or incomplete appeal can lock in a denial.
Can an ERISA Life Insurance Denial Be Challenged in Court?
In many cases, yes. After the appeal process is completed, beneficiaries may file a lawsuit in federal court. However, ERISA limits available damages and how courts review the denial.
Because of these limits, strategy and preparation during the appeal phase are essential.
Does a Denial Mean the ERISA Claim Is Over?
No. Many ERISA life insurance claims are denied initially and later paid after a properly handled appeal or court challenge. Early denials are common and often reversible.
Understanding the rules before responding makes a significant difference.
What to Do After an ERISA Life Insurance Claim Is Denied
If your ERISA life insurance claim has been denied:
• Obtain the denial letter and full plan documents
• Identify the exact reason given for denial
• Calendar all appeal deadlines carefully
• Gather supporting employment and enrollment records
• Avoid submitting an appeal without a clear strategy
ERISA claims reward preparation, accuracy, and early action.
Related Guidance
For a detailed overview of how ERISA life insurance denials are handled, see our Denied ERISA Life Insurance Claim page, and our Denied ERISA Life Insurance Claim Fact Sheet.
If an employer sponsored life insurance claim has been denied, it may still be possible to recover the full benefit under federal law.
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Written & Reviewed by Christian Lassen, Esq., Nationally recognized life insurance lawyer: 25 years experience, hundreds of millions recovered. Quoted in The Wall Street Journal ( May 17, 2025).
Last reviewed: Jan 3, 2026 | Contact 800-330-2274
Our FAQ
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A grace period is the time after a missed payment during which the policy remains in force, usually 30 to 60 days depending on state law and policy terms.
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No. In most states, insurers must send a written notice of overdue premiums and warn of pending lapse before terminating coverage.
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The policy may still be enforceable. Beneficiaries can challenge the lapse based on the insurer’s failure to provide required notice.
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Yes. If the insured dies during the grace period, the policy is still considered active, and benefits should be paid.
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Yes. In group life insurance policies, employers sometimes fail to forward premiums properly, leading to wrongful lapse denials.
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Yes. If automatic payment setups fail through no fault of the insured, lapses may be challenged.
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Some policies automatically borrow against cash value to cover missed payments. Failure to apply this correctly can lead to wrongful lapse claims.
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Possibly. Some courts excuse nonpayment if the insured was mentally incapacitated and missed premiums without proper notice.
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No. Reinstatement must occur while the insured is alive, but wrongful lapse denials can still be challenged posthumously.
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Not without following strict notice and grace period rules. Beneficiaries can often challenge technical denials.
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Deadlines vary by state, but it’s critical to act within 1 to 5 years depending on the policy and jurisdiction.
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Not necessarily. Payments mailed within grace periods or accepted by insurers may keep coverage active.
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Bank records, payment receipts, insurer correspondence, and premium notices are key evidence.
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If the insurer used an outdated address despite updated information, lapse denials can often be overturned.
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Possibly. If the insured submitted a reinstatement application before death, it may help challenge a lapse denial.
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In some states, special grace periods and protections applied during COVID-19 emergencies. They can help fight wrongful lapses.
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Only if the insurer followed all legal notice and grace period requirements. Otherwise, beneficiaries may still recover.
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Misapplied premiums can lead to wrongful lapses — and courts often hold insurers accountable for these errors.
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An attorney can obtain records, challenge improper lapses, negotiate settlements, and litigate if necessary to enforce payment.
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“The insurer said my wife’s death was suicide and refused to pay, citing a policy exclusion. I knew that wasn’t true. The team at Lassen Law proved the exclusion period had ended. They handled everything and got me justice.”- Robert S.
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With over two decades of exclusive focus on life insurance litigation, we’ve helped thousands of families recover wrongfully denied benefits. Our reputation for fast, strategic resolutions has made us a trusted national resource for complex claim disputes.
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