Group life insurance claims are sometimes denied when an insurer alleges that required evidence of insurability was never completed. These denials often arise after an employee increases coverage, pays higher premiums, and later dies, only for the insurer to assert that part of the coverage was never effective.
This type of denial frequently turns on administrative failures rather than anything the insured did wrong.
How Group Life Insurance Coverage Increases Work
Most employer sponsored group life insurance plans provide a base amount of coverage automatically. Employees are often allowed to elect additional supplemental coverage in increments, sometimes up to a maximum limit.
Depending on the plan, increased coverage may require evidence of insurability, which typically involves answering health questions or submitting medical information. The requirement is usually triggered at the time the increase is elected.
Where the Breakdown Commonly Occurs
Problems arise when:
The employee submits a coverage increase request
The employer approves the election
Payroll deductions increase
The insurer accepts higher premiums
No evidence of insurability is requested
Months or years later, after the insured’s death, the insurer may claim that the additional coverage never became effective because an insurability form was missing.
Why These Denials Are Often Challenged
Insurers generally cannot accept premiums for coverage and later deny that the coverage existed without explaining why the requirement was never enforced.
Courts and regulators often focus on:
Whether the insurer approved or acknowledged the increased coverage
Whether premiums were collected for the higher amount
Whether the insured was ever notified that additional steps were required
Whether the failure was administrative rather than intentional
When an insurer’s own processes caused the omission, denying benefits after death is often legally problematic.
Evidence of Insurability Explained
Evidence of insurability is intended to protect insurers before coverage is issued. It is not meant to be used retroactively after premiums have been accepted and coverage appears in force.
If an insurer fails to request evidence of insurability at the time of enrollment or increase, and continues to collect premiums, many courts view the coverage as effective.
Employer Versus Insurer Responsibility
Group life insurance claims often involve multiple parties. Employers typically handle enrollment and payroll deductions, while insurers issue policies and administer claims.
When errors occur, insurers sometimes attempt to shift responsibility to the employer or the employee. However, beneficiaries are generally not responsible for internal administrative failures.
ERISA Considerations
Most employer sponsored group life insurance plans are governed by ERISA. Under ERISA, insurers and plan administrators have fiduciary duties to act in the best interests of participants and beneficiaries.
Denying coverage based on an internal failure to request required documentation can raise serious ERISA compliance issues, especially when premiums were accepted without objection.
Common Red Flags in These Denials
Coverage increase denials often share similar features:
Premiums paid for months or years
No written notice that coverage was incomplete
No request for additional forms before death
Denial issued only after a claim is filed
Reliance on plan language not enforced in practice
These facts frequently support a challenge.
What Beneficiaries Should Do After This Type of Denial
If a group life insurance claim is denied based on missing evidence of insurability:
Request the full plan documents and policy
Obtain enrollment records and payroll history
Confirm when coverage increases were approved
Review whether the insurer ever requested additional documentation
Preserve all communications from the employer and insurer
These cases often depend on records created long before the claim was filed.
How This Issue Fits Into Group Life Insurance Denials
Denials based on alleged failure to submit evidence of insurability are a common subset of group life insurance disputes. They frequently overlap with broader issues involving denied ERISA life insurance claims and employer administrative errors.
For a broader explanation of how group life insurance denials are analyzed, see your Denied ERISA Life Insurance Claims page.