When an employer provided life insurance claim is denied, many families assume there is nothing they can do. That assumption is exactly what insurance companies rely on. Under federal law, specifically the Employee Retirement Income Security Act, commonly called ERISA, a denial is often just the beginning of the process, not the end.
In a recent case, our firm recovered $500,000 for the widow of an employee whose group life insurance claim had been denied. The insurer alleged that the employee had not properly enrolled in coverage and also questioned whether his wife was the valid beneficiary. Both claims were wrong, and both were successfully disproven through a targeted ERISA appeal strategy.
This case is a clear example of how employer life insurance denials frequently stem from administrative errors rather than valid coverage issues, and why ERISA claims must be handled differently from private life insurance disputes.
Why ERISA Life Insurance Claims Are Different From Private Policies
Employer sponsored life insurance is governed by federal ERISA law, not state insurance law. That distinction matters. ERISA imposes strict procedural rules that control how claims are handled, how denials are appealed, and what evidence a court is allowed to review later.
Under ERISA:
You must exhaust the insurer’s internal appeal process before filing a lawsuit
You are bound by short deadlines, often 180 days or less
Courts usually review only the administrative record created during the appeal
New evidence is often barred once the appeal window closes
This structure makes ERISA claims unforgiving. A strong appeal can win the case outright. A weak or incomplete appeal can permanently destroy an otherwise valid claim.
Common Reasons ERISA Life Insurance Claims Are Denied
ERISA denials often have little to do with the death itself. Instead, insurers focus on paperwork, enrollment technicalities, or missing documents. The most common denial grounds include:
Alleged Failure to Enroll Properly
Insurers frequently argue that the employee never completed enrollment or did not elect the correct coverage amount. This often happens when enrollment is handled online or through a third party platform.
Missing or Invalid Beneficiary Designations
Another frequent issue is a missing beneficiary form. Employers may retain beneficiary documents that never reach the insurer. The insurer then claims no valid beneficiary exists.
Disputes Over Employment Status
Insurers may claim coverage ended due to termination, leave of absence, or disability status, even when premiums continued or the plan allowed continued coverage.
Administrative Errors by the Employer
HR departments make mistakes. Under ERISA, those mistakes can still be attributed to the plan administrator or insurer, even though the employee did nothing wrong.
Case Example: Enrollment and Beneficiary Dispute That Led to a Wrongful Denial
Our client’s husband worked for a manufacturing company in northern Illinois and received group life insurance through his employer. He passed away unexpectedly while still employed. His wife promptly submitted a claim for the $500,000 benefit.
The insurer denied the claim, asserting two primary defenses:
The employee allegedly failed to complete proper enrollment
The beneficiary designation naming his wife was supposedly missing or invalid
Rather than accepting the denial, our firm conducted a full ERISA investigation.
We obtained internal employer records showing that the employee completed enrollment during open enrollment through the company’s digital system. Audit logs confirmed the date, time, and completion status. We also located the original beneficiary designation form, which had been scanned and stored in the employer’s HR files but never transmitted to the insurer.
The denial was not based on lack of coverage. It was based on broken internal processes.
Building a Winning ERISA Appeal
An ERISA appeal is not a casual request for reconsideration. It is the legal foundation of the entire case.
In this matter, our appeal included:
A detailed timeline of enrollment events
Employer affidavits confirming coverage elections
Certified copies of the beneficiary designation
Plan language analysis proving the insurer’s interpretation was incorrect
A legal memorandum explaining why the denial violated ERISA standards
We submitted the appeal within the required deadline and demanded a full and fair review as required under federal law.
Within sixty days, the insurer reversed its decision and paid the full $500,000 benefit to the widow.
What To Do If Your ERISA Life Insurance Claim Is Denied
If your claim is denied under an employer life insurance plan, immediate action is critical.
Review the Denial Letter Carefully
The denial letter outlines the insurer’s reasoning and identifies the plan provisions they rely on. These letters often misstate facts or stretch plan language beyond its meaning.
Request the Claim File and Plan Documents
You are entitled to the full claim file, the summary plan description, and the governing policy. These documents often reveal inconsistencies or missing information.
Act Before the Appeal Deadline Expires
Most ERISA plans allow only one appeal. Miss the deadline or submit an incomplete appeal, and the case may be lost permanently.
Treat the Appeal as the Lawsuit
Because courts often limit review to the administrative record, the appeal is effectively your trial. Evidence not submitted during the appeal may never be considered later.
Why ERISA Life Insurance Denials Require Experienced Legal Help
ERISA law strongly favors insurers. They design the plans, interpret the language, and control the claims process. Without experienced legal representation, beneficiaries are at a severe disadvantage.
Our firm handles ERISA life insurance disputes nationwide, including denials involving:
Enrollment errors
Missing beneficiary forms
Employer administrative failures
Coverage termination disputes
Improper plan interpretations
We understand how to build ERISA appeal records that force insurers to pay and position cases for success in federal court if litigation becomes necessary.
If your employer provided life insurance claim was denied, do not assume the insurer is right. Deadlines are short, and mistakes are costly. Contact our firm to review your denial and protect your right to the benefits your loved one earned.