Our life insurance attorneys successfully recovered a $20,000 death benefit after a State Farm life insurance claim was wrongfully denied. The policy was provided through the insured’s employer and governed by ERISA. State Farm denied the claim based on a procedural technicality rather than a substantive coverage issue. After a detailed ERISA review and a properly constructed administrative appeal, the denial was reversed and the full benefit was paid.
This case illustrates a common problem with employer provided life insurance. Claims are frequently denied not because coverage is excluded, but because insurers rely on strict ERISA procedures and assume beneficiaries will not challenge them correctly.
Why Employer Provided Life Insurance Falls Under ERISA
Life insurance offered through employment is governed by the Employee Retirement Income Security Act because it is part of an employer sponsored benefit plan. ERISA establishes uniform federal rules for how these plans must be administered, including disclosure obligations, fiduciary duties, and mandatory claim and appeal procedures.
While ERISA is intended to protect employees, it also significantly limits the rights of beneficiaries when a claim is denied. These limits make ERISA life insurance denials more difficult to overturn than denials involving privately purchased policies governed by state law.
How ERISA Life Insurance Denials Are Different
Strict Appeal Deadlines
ERISA requires beneficiaries to file an internal appeal within a short window, often 60 or 180 days. Missing this deadline can permanently bar recovery, even if the denial was wrong.
Mandatory Administrative Appeals
You cannot file a lawsuit until the internal appeal process is fully exhausted. Courts will dismiss ERISA cases that skip this step.
Limited Evidence Rules
Courts generally review only the administrative record created during the claim and appeal process. New evidence is usually not allowed later. This makes the appeal stage the most critical part of the case.
Deferential Court Review
Many ERISA plans give the insurer discretion to interpret the policy. When that language exists, courts review denials under an abuse of discretion standard, which favors the insurer unless the decision was unreasonable.
No Jury Trials
ERISA cases are decided by a federal judge, not a jury. This removes an important leverage point that exists in state law insurance cases.
No Bad Faith Damages
ERISA preempts state law claims for bad faith. Even if the insurer acted unfairly, recovery is usually limited to the unpaid benefit and sometimes attorney’s fees.
Common Procedural Traps in ERISA Life Insurance Claims
Insurers frequently deny ERISA life insurance claims based on technical or administrative grounds such as:
Alleged failure to submit required forms
Disputes over employment status
Incorrect beneficiary records
Missed deadlines or incomplete documentation
Internal plan interpretations not clearly disclosed to employees
In the State Farm case, the denial relied on a procedural argument that collapsed once the plan documents and ERISA regulations were properly applied.
How We Win ERISA Life Insurance Appeals
ERISA cases are won by building a complete and precise administrative record. Our approach includes:
Obtaining and analyzing the full plan document and summary plan description
Identifying procedural violations and fiduciary breaches
Submitting detailed legal appeals supported by evidence and case law
Preserving issues for federal court review if litigation becomes necessary
Many ERISA denials are reversed once insurers are forced to defend their decisions within the strict framework ERISA requires them to follow.
Help for Denied Employer Provided Life Insurance Claims
If your life insurance claim was denied and the policy came through your employer, you are likely dealing with an ERISA governed plan. These cases require a very different strategy than private life insurance disputes, and mistakes made early can permanently destroy an otherwise valid claim.
Our firm handles ERISA life insurance denials nationwide, including claims involving State Farm, Prudential, MetLife, Lincoln Financial, Voya, Hartford, and other major carriers. We work on a contingency fee basis. You pay nothing unless we recover benefits for you.
If your claim was denied based on a technicality, procedure, or administrative issue, it deserves immediate legal review.