When a life insurance claim is denied, the most important step is identifying the exact legal reason for the denial. Insurance companies often use vague language, incomplete explanations, or administrative phrasing that hides what actually caused the claim to be rejected. Until the real reason is identified, it is impossible to know whether the denial is valid or challengeable.
This is especially true for claims issued through Prudential and federal programs such as Servicemembers’ Group Life Insurance, Veterans’ Group Life Insurance, and Traumatic Servicemembers’ Group Life Insurance.
Start With the Denial Letter, Not Assumptions
Every insurer is required to state a reason for denial. The problem is that the stated reason is often incomplete or misleading. Phrases like “coverage not in force,” “ineligible beneficiary,” or “failure to meet program requirements” do not explain what actually went wrong.
The denial letter should be read carefully to determine whether the insurer is claiming:
No valid policy existed
The policy lapsed
A beneficiary issue exists
A misrepresentation occurred
An exclusion applies
Administrative requirements were not met
Each of these leads to a very different legal analysis.
Determine Whether the Denial Is Administrative or Substantive
Life insurance denials usually fall into one of two categories.
Administrative denials involve paperwork, timing, enrollment, or processing issues. These are common with group life insurance, SGLI, and VGLI claims.
Substantive denials involve allegations of misrepresentation, exclusions, or policy violations.
Identifying which category applies is critical because administrative denials are often easier to reverse.
Common Reasons Life Insurance Claims Are Denied
Lapsed or Allegedly Lapsed Coverage
The insurer may claim premiums were not paid or coverage ended. With SGLI and VGLI, this often involves a missed conversion window or alleged nonpayment after separation from service.
You must confirm whether premiums were actually unpaid, whether grace periods applied, and whether required notices were given.
Failure to Convert SGLI to VGLI
Veterans frequently lose coverage because the insurer claims the SGLI policy was not properly converted to VGLI within the required timeframe.
In many cases, the veteran attempted to convert coverage, but the application was mishandled or processed incorrectly.
Beneficiary Designation Conflicts
If the beneficiary form is outdated, missing, or conflicts with divorce orders or military records, insurers often delay or deny payment.
This frequently results in interpleader actions or prolonged administrative denials.
Alleged Misrepresentation on the Application
Insurers may claim the insured failed to disclose medical history, tobacco use, or other information. During contestability periods, even minor issues are used to deny claims.
The key question is whether the alleged misstatement was material and whether it was intentional.
Policy or Program Exclusions
Some policies exclude coverage for suicide within a certain period, specific activities, or certain types of deaths.
With federal programs, exclusions are governed by statute and regulation, not just policy language.
Employer or Military Administrative Errors
Many group life and military related denials stem from errors made by employers, HR departments, or military administrators.
Insurers still deny claims even when the insured reasonably believed coverage was in place.
Request the Full Claim File Immediately
Determining the real reason for denial usually requires more than the denial letter. You should request:
The full policy or program terms
Enrollment and conversion records
Beneficiary forms
Premium history
Internal claim notes
Any investigative reports
For ERISA governed plans, you have a legal right to the claim file.
Why Identifying the Correct Reason Matters
Appeals are not general complaints. They must directly address the legal basis of the denial. If you argue the wrong issue, you may permanently lose the claim.
This is especially dangerous in ERISA, SGLI, and VGLI cases, where only one appeal may be allowed.
When Legal Help Is Necessary
If the denial involves federal life insurance programs, employer provided coverage, or claims administered by large insurers, determining the reason for denial requires experience with insurance law, federal regulations, and claims administration.
Many valid claims are denied not because benefits are unavailable, but because beneficiaries do not challenge the correct issue.
Denied Life Insurance Claim? Start With the Right Analysis
Before appealing, negotiating, or giving up, the reason for denial must be identified precisely. Once that reason is known, the claim can be evaluated properly.
If your life insurance claim was denied and the explanation feels unclear, incomplete, or wrong, professional review can make the difference between a permanent denial and a full payout.
If you want help determining why a claim was denied and whether it can be overturned, that is the right place to start.