ERISA life insurance litigation is unlike any other type of insurance dispute. When a life insurance policy is provided through an employer, federal law controls nearly every aspect of the claim. That law, the Employee Retirement Income Security Act, sharply limits what beneficiaries can recover and how they are allowed to fight back.
Under ERISA, beneficiaries generally cannot sue for punitive damages, emotional distress, or bad faith. Instead, lawsuits are limited to recovering the denied benefit itself, potential attorney’s fees, and in some cases equitable remedies such as reinstatement of coverage or surcharge when serious procedural violations occur. Just as important, ERISA requires beneficiaries to exhaust the plan’s internal appeal process before filing any lawsuit. Missing that step or missing a deadline can permanently bar recovery.
Because of these restrictions, ERISA life insurance cases are often won or lost long before a lawsuit is filed.
Common ERISA Life Insurance Disputes We Litigate
ERISA life insurance disputes usually arise from administrative breakdowns rather than intentional wrongdoing by the insured. Some of the most frequent issues we handle include:
• Denial of coverage due to late, incomplete, or lost enrollment paperwork
• Claims denied because of alleged policy lapse tied to employer payroll errors
• Disputes over the proper beneficiary under plan documents
• Denials based on suicide, misrepresentation, or contestability exclusions
• Employer failure to notify employees of coverage termination or plan changes
• Conversion or portability rights not disclosed after employment ends
These cases often involve employees who believed they were covered and beneficiaries who had no reason to suspect a problem until the claim was denied. ERISA litigation focuses heavily on whether the employer or insurer followed required procedures and whether the denial decision was reasonable under the plan.
Why ERISA Cases Are Procedurally Unforgiving
ERISA does not allow jury trials. Judges decide cases almost entirely on written submissions. There is no opportunity to tell your story in court or present new evidence after the administrative appeal closes.
The administrative appeal is not a formality. It becomes the evidentiary record the court reviews. If a document, argument, or clarification is not included during the appeal, the judge will almost certainly refuse to consider it later.
This structure gives insurers and plan administrators a major advantage unless the appeal is handled strategically.
Step by Step Breakdown of the ERISA Litigation Process
Pre Litigation and Administrative Appeal
After a claim denial, ERISA requires the beneficiary to submit an internal appeal to the plan administrator. This deadline is usually between 60 and 180 days and is strictly enforced.
During this phase, the goal is not simply to ask the insurer to reconsider. The goal is to build a complete administrative record that proves coverage, exposes procedural errors, and preserves arguments for court review.
We routinely submit:
• Enrollment and payroll records
• Employer communications and HR confirmations
• Beneficiary forms and plan summaries
• Legal briefing explaining ERISA violations
• Evidence showing inconsistent or biased claim handling
If this step is mishandled, courts will often dismiss the lawsuit regardless of how unfair the denial appears.
Filing the Federal Lawsuit
If the appeal is denied, litigation begins in federal court. Most ERISA life insurance lawsuits are filed under Section 502(a)(1)(B), which allows participants and beneficiaries to recover benefits due under the plan.
The complaint focuses on plan language, the denial rationale, and procedural defects. ERISA complaints are highly technical and must be carefully drafted to align with the administrative record.
The Defendant’s Answer and Defenses
The insurer or plan administrator will file an answer admitting or denying allegations. Common defenses include:
• Alleged failure to exhaust administrative remedies
• Reliance on discretionary authority under the plan
• Claimed application of exclusions or lapses
• Arguments that the denial was reasonable
At this stage, the standard of review becomes critically important.
Discovery in ERISA Cases Is Limited
Most ERISA cases involve little or no discovery. Courts typically restrict review to the administrative record.
However, limited discovery may be allowed if there is evidence of:
• Conflict of interest
• Inconsistent claim handling
• Procedural irregularities
• Failure to follow ERISA regulations
When permitted, discovery often focuses on internal claims handling practices rather than factual issues surrounding the death.
Summary Judgment Is the Deciding Moment
ERISA cases are usually resolved through cross motions for summary judgment. The judge reviews the record and determines whether the denial was:
• Arbitrary and capricious, or
• Subject to de novo review
If the plan grants discretion to the administrator, courts usually apply a deferential standard. If not, or if serious procedural violations occurred, courts may review the claim from scratch.
This distinction often determines the outcome.
Trial and Appeals
Bench trials are rare but possible. More commonly, cases end at summary judgment or settle once the record is fully developed.
Either party may appeal to the federal circuit court, particularly when issues involve plan ambiguity or procedural violations with broader implications.
Why Legal Representation Is Critical in ERISA Life Insurance Claims
ERISA litigation is paper driven and deadline driven. Judges do not give second chances. A weak appeal cannot be fixed later, and a missed deadline is often fatal.
Our firm focuses on building aggressive administrative appeals, identifying ERISA violations early, and positioning cases for either reversal or settlement. We understand how insurers structure denials and how courts evaluate those decisions under federal law.
In one recent case, an insurer denied coverage based on alleged failure to submit evidence of insurability. During the appeal, we submitted employer records and internal communications showing the requirement had been waived for similarly situated employees. The insurer reversed the denial without litigation.
Frequently Asked Questions About ERISA Life Insurance Litigation
What life insurance policies are governed by ERISA?
Most employer sponsored life insurance policies are governed by ERISA, including group plans and voluntary supplemental coverage.
Can I sue for bad faith under ERISA?
No. ERISA preempts state bad faith claims. Recovery is limited to benefits, attorney’s fees, and equitable relief.
How long do I have to appeal an ERISA denial?
Most plans allow between 60 and 180 days. Missing the deadline usually ends the case.
What if my employer caused the coverage problem?
Employers can be held responsible when their administrative failures lead to loss of coverage.
Is discovery allowed in ERISA cases?
Usually no, but courts may allow limited discovery if procedural violations or conflicts of interest exist.
Are ERISA cases decided by juries?
No. All ERISA cases are decided by judges.
Can attorney’s fees be recovered?
Yes, courts may award reasonable attorney’s fees to prevailing beneficiaries.
What if the employee died shortly after leaving employment?
Failure to provide notice of conversion rights is a common basis for recovery.
Can an old ERISA denial still be challenged?
Possibly. Statutes of limitation apply, but tolling may be available if the beneficiary was misled or unaware.
How long does ERISA litigation take?
Most cases resolve within 6 to 18 months, depending on complexity and appeals.
Final Takeaway
ERISA life insurance litigation is technical, restrictive, and unforgiving, but it is not unwinnable. Insurers rely on beneficiaries missing deadlines, misunderstanding the process, or accepting denials as final. With the right legal strategy, many ERISA denials can be overturned or resolved favorably.
If your employer provided life insurance claim has been denied, early action and proper appeal handling are essential. The administrative appeal is not just a step. It is the case.