Denied ERISA Life Insurance Claim? We Just Recovered $500,000 for a Client—Here’s What You Need to Know
If your life insurance claim was denied under an employer-sponsored policy, chances are it falls under the Employee Retirement Income Security Act (ERISA). Navigating a denied ERISA life insurance claim can be daunting—but you don’t have to face it alone. Our law firm recently recovered $500,000 for a client whose claim was wrongfully denied under ERISA regulations. With the right legal help, you can appeal the decision and potentially recover the full death benefit.
What Makes ERISA Life Insurance Claims Different?
ERISA governs most group life insurance policies provided by employers. While these policies offer affordable coverage, ERISA limits your rights in significant ways—especially when a claim is denied. Unlike privately purchased life insurance policies, ERISA claims must follow a strict administrative process before you can even file a lawsuit in federal court.
If your claim has been denied, the clock is ticking. Most plans only give you 180 days to appeal the denial—and if you miss this deadline, you could lose your right to any further review.
Steps to Take After an ERISA Life Insurance Denial
Our attorneys handle every stage of the ERISA appeal process. Here’s how we approach it:
Step 1: Review the Denial Letter Thoroughly
An experienced life insurance lawyer must examine the denial letter to identify the exact reasons for the denial and the specific plan provisions the insurer relied on. These letters often include complex and misleading language, which we can decipher and challenge appropriately.Step 2: Gather Supporting Documentation
We work closely with beneficiaries to compile all relevant documents—this includes the full insurance policy, employer plan documents, medical records, beneficiary forms, and any correspondence with the insurer or employer.Step 3: File a Written Appeal Within the Deadline
ERISA gives you 180 days from the date of the denial to file your administrative appeal. This is your only chance to submit evidence—once the appeal window closes, no new information can be introduced later in court.Step 4: Review the Insurer’s Response
The insurer is required to respond within 45 days (or 90 if they claim special circumstances). They must provide a detailed explanation for their decision, including citations to policy provisions and any expert opinions they relied on. We scrutinize every line for errors, inconsistencies, and legal weaknesses.Step 5: Request an External Review (if available)
Some plans offer or require an external review by an independent evaluator. This option must typically be requested within four months of the second denial. External reviews can help expose flawed reasoning or biased medical opinions used to deny your claim.Step 6: File a Federal Lawsuit If Necessary
If internal and external appeals fail, we prepare a legal brief and file a lawsuit in federal court. ERISA litigation is different from standard insurance lawsuits—it’s often decided by a judge without a jury, based solely on the administrative record. This is why building a strong appeal file early on is crucial.
How We Won a $500,000 ERISA Claim After a Denial
In our recent case, the insurer denied the claim based on alleged inconsistencies in the policyholder’s enrollment documentation and questioned the validity of the beneficiary designation. After a thorough review, we uncovered that the insurer had failed to consider critical documents from the employer and improperly interpreted plan terms. We submitted a comprehensive appeal and legal memorandum, forcing the insurer to reverse its decision and pay the full $500,000 death benefit.
Frequently Asked Questions
What is ERISA and how does it impact my life insurance claim?
ERISA is a federal law that governs most employer-provided benefits, including life insurance. It imposes strict rules for how claims and appeals must be handled and requires claimants to complete an administrative appeal before filing a lawsuit.
Can I sue the insurance company immediately after a denial?
No. Under ERISA, you must first exhaust the administrative appeal process. Only after a valid appeal is denied can you file a lawsuit in federal court.
How long do I have to appeal a denied ERISA life insurance claim?
You typically have 180 days from the date of the denial letter to file your appeal. If you miss this deadline, your right to contest the denial may be lost.
What documents should I include in my appeal?
Include the denial letter, a detailed appeal letter from your attorney, all relevant medical records, plan documents, policy language, employment records, and anything that supports your right to the benefit.
Do I need a lawyer for an ERISA appeal?
Yes. ERISA claims are highly technical, and courts often defer to the insurer’s decision unless you can prove it was unreasonable. Having a lawyer build the appeal record gives you the best chance at success in both the appeal and any potential lawsuit.