A denied life insurance claim does not mean the insurer’s decision is final. In many cases, denials are reversed when challenged correctly. The key is understanding why the claim was denied, preserving your appeal rights, and responding with a legally sound strategy rather than emotion or guesswork.
Below is a step by step guide to appealing a denied life insurance claim the right way.
Step 1: Get the Exact Reason for the Denial in Writing
Insurance companies must provide a written explanation for denying a claim. Do not rely on phone calls or vague statements. Request a denial letter that clearly states:
The specific policy provision relied upon
The factual basis for the denial
Whether the decision is final or subject to appeal
Any deadlines for appealing
If the letter uses vague phrases like policy provisions, underwriting concerns, or investigation ongoing, request clarification immediately.
Step 2: Determine What Type of Policy You Are Dealing With
The appeal process depends heavily on the type of policy involved.
Individual life insurance policies are governed by state law.
Employer provided group life insurance policies are usually governed by ERISA.
Federal programs like SGLI or VGLI follow separate federal rules.
This matters because ERISA policies often allow only one appeal. If that appeal is mishandled, you may permanently lose your right to challenge the denial.
Step 3: Obtain the Entire Policy and Claim File
You cannot appeal a denial without reviewing the full policy and the insurer’s internal claim file.
You should obtain:
The complete policy, including riders and endorsements
The application and underwriting documents
Medical records reviewed by the insurer
Internal claim notes and investigation reports
Any expert opinions relied upon
For ERISA policies, you have the right to request the claim file. This is critical because insurers often deny claims based on incomplete or inaccurate internal reviews.
Step 4: Identify the Legal Weakness in the Denial
Most denials fall into predictable categories:
Alleged misrepresentation on the application
Lapsed policy due to missed premiums
Suicide or drug related exclusions
Cause of death disputes
Beneficiary conflicts
Administrative or employer errors
The appeal must directly address the legal standard that applies to that category. General arguments or emotional appeals do not work. The response must show why the insurer misapplied the policy or violated the law.
Step 5: Do Not Submit a Casual or Incomplete Appeal
This is where many beneficiaries make irreversible mistakes.
An appeal is not a letter asking the insurer to reconsider. It is a legal submission that should include:
Policy interpretation
Medical or factual rebuttal
Applicable case law
Regulatory violations if applicable
Supporting documentation
For ERISA policies, whatever you submit becomes the permanent administrative record. You usually cannot add new evidence later in court.
Step 6: Watch the Deadlines Carefully
Appeal deadlines are strict.
Some policies allow 30 days. Others allow 60 or 180 days. Missing the deadline can permanently bar recovery even if the denial was wrong.
Do not wait until the last minute. Insurers count on delay and confusion.
Step 7: Know When Legal Help Is Necessary
Appeals involving the following almost always require experienced legal handling:
Contestability period denials
Suicide or self inflicted injury exclusions
Drug or alcohol exclusions
ERISA governed group policies
Beneficiary disputes or interpleaders
Foreign death claims
In these cases, the insurer is already preparing for litigation. Responding without legal strategy puts you at a severe disadvantage.
Common Mistakes to Avoid
Accepting the denial at face value
Appealing without reviewing the full policy
Submitting emotional letters instead of legal arguments
Missing appeal deadlines
Talking to the insurer without documenting communications
The Bottom Line
A life insurance denial is often the opening move, not the final decision. Many denials are reversed when challenged properly, especially when the insurer relies on vague policy language, incomplete investigations, or assumptions unsupported by evidence.
If your claim has been denied or stalled, the most important thing you can do is slow down, gather the right documents, and make sure your appeal is done correctly the first time.