ERISA applies to most employer-sponsored life insurance policies, especially those offered by private-sector companies. These are typically group life plans, often part of an employee benefits package.
However, there are two key exceptions where ERISA does not apply:
Government plans (such as policies for federal, state, or municipal employees)
Church-sponsored plans (unless the plan administrator elects ERISA coverage)
If your loved one worked for a private employer, it’s very likely that ERISA governs the life insurance claim. But confirming that should be your first step, especially before filing an appeal. if you need a South Dakota life insurance denial attorney call today.
How to Tell If ERISA Applies to Your Policy
You may not need to contact a lawyer just to answer this question. Instead, look at how the employer is involved with the insurance coverage. A life insurance plan is likely governed by ERISA if the employer does any of the following:
Pays for some or all of the premiums
Encourages enrollment in the policy during onboarding or open enrollment
Retains control of administrative tasks, like enrollment tracking or claim processing
Handles employee questions related to plan coverage
Provides plan documents such as a Summary Plan Description (SPD)
If these apply, you are almost certainly dealing with an ERISA claim—and it must be handled carefully and within strict legal timelines.
Why ERISA Claims Are Frequently Denied
Unlike individual life insurance policies, ERISA-governed claims must go through a structured appeals process before you can even bring a lawsuit. Life insurance companies and plan administrators often deny claims for the following reasons:
Alleged failure to enroll properly
Missing premium payments (sometimes due to employer error)
Lapse in coverage at the time of death
Disputes over change of beneficiary forms
Technical noncompliance with plan terms
Even if the denial seems minor or fixable, the insurance company may use it as justification to refuse payment. That’s why it’s essential to know your rights and follow ERISA’s unique rules for appeals.
How the ERISA Appeals Process Works
If your claim is denied, ERISA requires the insurance company to send you a written denial letter explaining:
Why the claim was denied
What evidence was used in making the decision
How and when to submit an appeal
The deadline to file that appeal (usually 60 or 180 days)
Do not ignore this deadline. If you miss it, you could lose your right to challenge the denial in court—no matter how strong your case may be.
Unlike other types of insurance disputes, you cannot file a lawsuit under ERISA unless you first complete the appeal process through the insurer or plan administrator. This is a critical legal step that must be handled with care.
Why Legal Help Is Essential in ERISA Life Insurance Claims
ERISA is extremely technical, and unlike other claims, you do not have the right to a jury trial. Any lawsuit that follows a denial is decided by a judge, based only on the administrative record—meaning the documents you submit during the claim and appeal stages. If you don’t raise an issue during the appeal, you may not be able to raise it later in court.
For that reason, hiring an attorney before or during the appeal is one of the smartest decisions you can make. An experienced ERISA life insurance attorney can:
Analyze the policy and plan documents
Ensure you meet all filing deadlines
Gather and submit the correct evidence
Challenge the insurer’s interpretation of policy terms
Prepare a complete administrative record for potential litigation
We regularly help families who are devastated by the sudden loss of a loved one, only to face the added pain of a denied life insurance payout.
When to Contact an ERISA Life Insurance Attorney
The best time to contact a lawyer is as soon as you receive notice of a denial—or even before filing the claim, if the death involved unique circumstances such as:
The employee had recently left their job
There were questions about active coverage
A policy conversion form was filed but never processed
Beneficiary designations are being contested
The claim involves supplemental coverage (AD&D, spouse, or dependent riders)
These are all red flags that your claim might be denied or delayed. The earlier an attorney gets involved, the better your chances of recovering the benefit you’re entitled to.
Don’t Let a Denial Under ERISA Be the Final Word
Life insurance benefits exist to protect your family after an unthinkable loss. When those benefits are denied for technical or unjust reasons, it can turn grief into financial ruin.
We understand the ins and outs of ERISA and how insurance companies exploit the process. If your claim has been denied—or if you suspect that one will be—we invite you to call our office for a free consultation. You won’t pay a dime unless and until we recover money for you.