If you’ve received a denial letter for a life insurance policy governed by ERISA (the Employee Retirement Income Security Act of 1974), you are not alone. Many employer-provided life insurance claims are wrongfully denied based on technicalities, vague exclusions, or administrative missteps. Unfortunately, ERISA laws often work in favor of insurance companies, placing strict limits on the rights of beneficiaries and restricting the scope of appeal. At our firm, we’ve handled thousands of denied ERISA claims and successfully fought insurers like MetLife, Prudential, Lincoln Financial, Unum, Hartford, and others to recover the full policy benefits our clients are owed. If your loved one had group life insurance through their employer, understanding why the claim may have been denied is the first step toward reversing that decision.
Top 20 Reasons ERISA Life Insurance Claims Are Denied
1. Non-payment of premiums: If premium deductions from payroll stop—due to unpaid leave, resignation, or administrative error—the policy may lapse. Many employees are unaware that their coverage ended, and insurers often fail to give proper notice. Even if premiums were missed by mistake, insurers can use this to avoid payment.
2. Misrepresentation on the application: Inaccurate statements about health, smoking status, or income during the initial enrollment can lead to denial if discovered during the contestability period. Insurers may rescind the policy entirely if they believe the misrepresentation was material to their risk assessment.
3. Failure to disclose a pre-existing medical condition: ERISA insurers may deny a claim if they determine that the deceased failed to report a known illness. Even if the death wasn’t directly caused by that condition, they may argue that the nondisclosure voids the contract.
4. Death occurred outside of the coverage period: If the insured passed away before coverage began or after it ended—such as during a job transition or while on unpaid leave—the insurer will likely claim that the policy was not in effect at the time of death.
5. Suicide or self-inflicted injury within the first two years of coverage: Most ERISA-governed policies have a two-year suicide exclusion. If death is ruled a suicide within that period, the insurer may deny payment and return only the premiums paid.
6. Death resulting from an excluded cause, such as high-risk activities: ERISA plans may exclude deaths from skydiving, scuba diving, mountaineering, or racing. If the insured participated in such activities—even recreationally—the insurer may use that as a reason to avoid payout.
7. Death resulting from an act of war or terrorism: Some policies exclude deaths occurring in war zones or terrorist incidents. This is particularly relevant for government contractors or employees working overseas. Even if the insured was not actively involved, the insurer may attempt to invoke this exclusion.
8. Death resulting from drug or alcohol use: If toxicology reports indicate that the insured had alcohol or drugs in their system, the insurer may argue that the death was due to intoxication and deny the claim—even in accidental deaths like falls or vehicle accidents.
9. Death resulting from an illegal act or criminal activity: ERISA insurers often deny claims when the insured dies during illegal behavior. This could range from minor offenses to serious criminal acts. Even a car accident during an unlicensed drive could trigger a denial.
10. Death resulting from participation in a felony: If the insured was committing a felony at the time of death—such as burglary or assault—insurers may apply a felony exclusion, regardless of whether the act directly caused the death.
11. Failure to provide adequate proof of death or cause of death: Incomplete or unclear documentation can stall or stop a claim. If the death certificate lists an “undetermined” cause or lacks detail, the insurer may request additional records or deny the claim entirely.
12. Failure to comply with the policy’s notice and filing requirements: ERISA plans have strict administrative timelines. If the claim wasn’t filed within the required window (usually 30 to 90 days), the insurer may reject it as untimely—even if the delay was due to mourning or confusion.
13. The policy was not in force at the time of death: Coverage may have ended due to unpaid premiums, employment changes, or administrative cancellation. Many employees are unaware that a policy lapsed or was terminated until a claim is denied.
14. The beneficiary was not properly designated or is contested: If the beneficiary form was never submitted, is missing, or is challenged by another party, the insurer may withhold payment or initiate an interpleader lawsuit, delaying resolution for months.
15. The policy lapsed due to non-payment or other reasons: Employers may fail to process benefit elections or premium deductions properly. If a policy lapses without the insured’s knowledge, the insurer can use that to escape liability—even if the error was not the employee’s fault.
16. The policy was obtained fraudulently or through misrepresentation: If someone forged enrollment forms or submitted false information on behalf of the insured, the policy may be voided posthumously. This is especially common in dependent life insurance cases.
17. The death occurred during a period of contestability: If the insured died within the first two years of policy activation, the insurer may scrutinize the application and medical history in search of reasons to deny the claim, even for minor inaccuracies.
18. The policy was terminated or canceled by the insurer or the policyholder: Group life coverage can be canceled if the employer discontinues benefits or switches providers. If the insured did not convert to an individual plan, coverage may not be in effect.
19. The policyholder did not have authority to obtain coverage on the insured person: In some dependent policies, if the insured (such as a spouse or child) did not consent or wasn’t eligible, the claim may be denied on the basis of lack of insurable interest or authority.
20. The policy was not properly assigned or transferred: If the policy was transferred to a trust or reassigned and the paperwork was not executed correctly, the insurer may challenge the validity of the assignment and delay or deny payment.
Why ERISA Claims Require a Life Insurance Attorney
Unlike private policies, ERISA claims are governed by federal law, which imposes strict rules on timelines, documentation, and legal process. You don’t get a jury trial. You don’t get to present live witnesses. You may be limited to what’s in the insurer’s “administrative record.” This means a mistake at the claim stage can destroy your appeal later. Our attorneys know how to strategically challenge ERISA denials by securing all relevant records, identifying procedural violations, and filing persuasive appeals. If the insurer refuses to pay, we’re ready to file suit in federal court and fight for the full benefit—including interest and attorney’s fees.
Contact Our ERISA Life Insurance Lawyers Today
If your ERISA life insurance claim was denied, do not wait. Deadlines are tight and missing one could destroy your right to recover benefits. We’ve helped thousands of families navigate the ERISA appeals process and secure payment—even after initial denials. Call us now at 800-330-2274 or use the form on this page to request a free consultation.
FAQ: ERISA Life Insurance Claim Denials
What is ERISA and how does it affect life insurance claims?
ERISA is a federal law that governs most employer-provided benefits, including group life insurance. It establishes strict rules for claims, appeals, and litigation. Unlike individual policies governed by state law, ERISA limits your ability to sue and the kind of evidence you can use.
Can a claim be denied even if the policy was active?
Yes. Insurers can deny claims based on exclusions like suicide, intoxication, criminal acts, or alleged misrepresentations—even if the policy was active at the time of death.
What should I do after receiving a denial letter?
Review the denial reason and deadlines listed in the letter. Then contact a life insurance attorney immediately to begin the appeal process. Do not attempt to appeal on your own without legal help—ERISA appeals are legally technical.
How long do I have to appeal an ERISA life insurance denial?
Most plans give you 60 to 180 days from the date of denial to file an administrative appeal. If you miss this deadline, you may lose your right to pursue the claim in court.
Can I sue the insurance company if my appeal is denied?
Yes, but only after exhausting the plan’s internal appeals process. Once the appeal is complete, you may file a lawsuit in federal court under ERISA. However, you are generally limited to the evidence in the insurer’s claim file.
Can I add new evidence during my ERISA appeal?
Yes, but only at the appeal stage. Once the administrative appeal is over, new evidence cannot be introduced in court. That’s why involving a lawyer early is so important.
Is suicide always excluded from life insurance?
No, but most policies have a suicide exclusion during the first two years. After that period, suicide is typically covered unless excluded by specific policy language.
Can beneficiaries be changed without notifying them?
Yes, as long as the insured properly fills out and submits a new beneficiary designation. However, if a dispute arises or the form is missing, the insurer may delay payment.
What happens if multiple people claim to be the rightful beneficiary?
The insurer may file an interpleader lawsuit, deposit the funds with the court, and let a judge decide. This can delay resolution but protects the insurer from double liability.
Do state laws apply to ERISA life insurance claims?
Generally no. ERISA preempts most state laws, including those governing bad faith, punitive damages, and automatic revocation of ex-spouses as beneficiaries.
What if the employer made a mistake that caused coverage to lapse?
You may still recover benefits if the lapse was due to the employer’s error or failure to notify the employee. Legal representation is often necessary to challenge these denials.
Can an attorney help with paperwork and deadlines?
Yes. A life insurance lawyer can manage the entire appeals process, handle communication with the insurer, gather necessary documents, and file suit if needed.
Is there a fee for your legal services?
We work on a contingency basis, meaning you pay nothing unless we win your case. We also offer free consultations to review your denial and explain your legal options.