To challenge a denial under ERISA, you must first file an administrative appeal with the insurance company—typically within 60 to 180 days. If that fails, you can then file a lawsuit in federal court. This process requires careful legal preparation, complete documentation, and a firm understanding of ERISA’s unique rules.If you have an Indiana life insurance policy dispute call us.
Step-by-Step Guide to Appealing a Denied ERISA Life Insurance Claim
Step 1: Read the Denial Letter in Detail
Start by examining the denial letter from the insurance company. This letter should explain why your claim was denied and cite the specific policy provisions or missing documents. For example, your denial might say the insured failed to complete an Evidence of Insurability form, or that coverage lapsed without notice.
Example: A widow in Pittsburgh received a denial letter stating her late husband’s coverage ended before his death. Upon review, it was discovered that the employer had failed to submit the required payroll deduction records to the insurer. That clue became central to the appeal.
Step 2: Collect All Supporting Evidence
The burden falls on the beneficiary to present a complete and convincing case during the appeal. This means collecting all documents that strengthen your position, such as:
Medical records proving insurability
Pay stubs confirming premiums were paid
Internal HR communications
Emails or enrollment confirmations
The full policy document and any riders
Example: In a Texas case, a daughter successfully appealed a denial by submitting email evidence showing her father was auto-enrolled during open enrollment—and never received the opt-out paperwork.
Step 3: Comply with the Strict ERISA Deadline
You typically have 60 to 180 days to file an appeal depending on the plan. This deadline is firm. If you miss it, your ability to sue in federal court may be lost forever.
Example: In a Florida case, a beneficiary was denied because she waited 9 months to appeal. The court dismissed the lawsuit because she missed the ERISA deadline—even though the denial may have been wrongful.
Step 4: Work with an ERISA Life Insurance Attorney
ERISA law is technical and favors insurance companies unless the beneficiary builds a thorough appeal record. An experienced life insurance attorney can:
Identify legal flaws in the denial
Draft a compelling administrative appeal
Ensure that all evidence is properly submitted
Preserve your right to sue in federal court if needed
Example: A Minnesota family was denied a $300,000 claim due to a supposed misstatement on the application. Their attorney uncovered that the employer had pre-filled the form incorrectly. The appeal succeeded without court intervention.
What Happens After You File the Appeal?
1. Administrative Appeal Review
Once you submit your appeal, the insurance company must conduct a full and fair review—typically within 60 days. Your attorney will prepare a detailed brief addressing every point in the denial and attaching all supporting documentation.
2. Federal Lawsuit (If the Appeal Is Denied)
If the appeal fails, you can sue the insurer under ERISA in federal court. You won’t get a jury trial; instead, a judge will review the case based solely on the “administrative record”—meaning everything you submitted during the appeal.
mportant: You cannot add new evidence once the case goes to court. That’s why it’s critical to get everything into the record during the appeal stage.
3. Judge-Only Trial
Unlike typical lawsuits, ERISA cases are decided by a judge—no jury is involved. The judge will decide whether the insurer abused its discretion or failed to act in the best interests of the beneficiary.
Common Reasons ERISA Life Insurance Appeals Fail
Even valid claims can be lost due to technical missteps. Here are the most frequent problems:
Incomplete Claim File
If your appeal omits critical documents—like premium records, enrollment forms, or medical authorizations—the insurer may uphold the denial due to lack of evidence.
Missed Deadlines
ERISA deadlines are unforgiving. A late appeal—even by one day—can result in your case being dismissed entirely.
Failure to Use Written Communication
Phone calls don’t count. Always communicate in writing. Insurance companies can deny claims when beneficiaries rely on verbal instructions or fail to follow formal procedures.
Ignoring Policy Language
Appeals must address the exact policy terms cited in the denial. Generic arguments or emotional pleas won’t succeed under ERISA rules.
Lack of Legal Help
Trying to handle an ERISA appeal without legal guidance often leads to avoidable mistakes. ERISA laws are complex, and most policies are written to favor insurers.
Call a Life Insurance Attorney Before It’s Too Late
If your group life insurance claim has been denied and is governed by ERISA, time is of the essence. You may only have weeks to take action—and the appeal must be airtight to succeed. Our law firm specializes in overturning denied ERISA life insurance claims nationwide. We’ll review your denial for free and fight to get you the benefits you’re owed.