Few life insurance denial letters rely on language as deceptively simple as this:
“The insured was not actively at work on the effective date of coverage.”
For decades, active at work requirements were relatively straightforward. If an employee was physically present and performing regular duties, coverage attached. If they were out sick or on leave, coverage could be delayed or limited.
But the rise of remote work and hybrid schedules has complicated everything.
Today, insurers increasingly challenge coverage by arguing that a remote or hybrid employee was not “actively at work” under the terms of the plan. These disputes often hinge on outdated definitions being applied to modern work arrangements.
Here is how these cases arise and what actually matters.
What “Active at Work” Typically Means
Most employer sponsored group life insurance policies contain an active at work clause. It usually requires that, on the effective date of coverage, the employee must:
• Be performing the material duties of their regular occupation
• Be working the required minimum number of hours
• Not be confined due to sickness or injury
• Not be on a leave of absence
The policy language controls, and the exact wording varies by plan.
The dispute often turns on whether the employee was performing their regular duties, not whether they were physically present in an office.
Why Remote Work Creates Confusion
Before widespread remote work, insurers often equated “active at work” with physical presence at the workplace.
That assumption no longer fits reality.
Remote and hybrid employees may:
• Work full time from home
• Split time between home and office
• Travel while performing job duties
• Log in virtually while temporarily ill
If the employee was performing job duties from home on the effective date, insurers may still argue they were not “actively at work” if:
• They were working reduced hours
• They were transitioning into medical leave
• They logged in briefly but were medically compromised
• The employer coded them as inactive in payroll
These disputes are fact intensive and depend heavily on documentation.
Common Denial Scenarios
Enrollment During Illness
An employee elects supplemental life insurance during open enrollment. On the effective date, they are working from home while undergoing medical treatment.
The insurer later argues the employee was not actively at work because they were not fully capable of performing all job duties.
The employee’s login records, emails, and calendar activity may tell a different story.
Hybrid Schedule Misunderstandings
A hybrid employee normally works three days in the office and two days remotely. The effective date falls on a scheduled remote day.
The insurer questions whether the employee was “present” at work, even though remote work was a standard part of the role.
Plan language often focuses on duties performed, not physical location.
Administrative Coding Errors
The employee continues working remotely but HR changes their internal status to reflect medical leave starting the following week.
The insurer relies on HR coding rather than the employee’s actual work activity.
In many cases, payroll and IT records contradict the carrier’s conclusion.
What Evidence Matters Most
Active at work disputes are won or lost on documentation.
Helpful evidence includes:
• Email activity and timestamps
• Calendar entries and meeting participation
• VPN or system login logs
• Work product created on the relevant date
• Supervisor statements confirming active duties
• Payroll records reflecting active status
• Job descriptions showing remote duties were normal
The central question is whether the employee was performing the material duties of their occupation, not whether they were sitting in a specific building.
The ERISA Factor
Most employer sponsored life insurance plans are governed by federal ERISA law.
In ERISA cases, courts often review the insurer’s decision based on the administrative record. That means the appeal stage is critical.
If you have evidence showing the employee was actively performing job duties remotely, it must be submitted during the appeal. Waiting until litigation may be too late.
A strong appeal often includes:
• Detailed timeline of work activity
• Supporting documentation from supervisors
• Copies of relevant policy language
• Explanation of the employer’s remote work policies
Modern work structures should not be treated as technical loopholes to deny coverage.
The Bigger Issue
Active at work clauses were written in a different era. The workplace has changed dramatically, but many insurers still apply rigid interpretations that do not reflect remote and hybrid realities.
If an employee was fulfilling their job responsibilities, communicating with colleagues, and producing work, that fact can outweigh assumptions about physical presence.
The outcome depends on the plan language, the factual record, and how clearly the evidence is presented.
The Bottom Line
Active at work disputes involving remote or hybrid employees are increasingly common in group life insurance denials.
The key question is whether the employee was performing the material duties of their occupation on the relevant date. Physical location alone should not control the outcome.
If your claim was denied based on an active at work clause and the employee was working remotely, the denial may not be the final word. With the right documentation and a carefully built appeal, these technical disputes can often be challenged successfully.