Few life insurance denials feel more unfair than this one.
The employee enrolled. Premiums came out of every paycheck. HR confirmed coverage. Sometimes the family even received benefit summaries showing an active policy.
Then after death, the insurer says the claim is denied because “Evidence of Insurability” was never submitted.
In other words, the carrier claims coverage never became effective, even though everyone acted as if it did.
This scenario comes up constantly in employer provided life insurance claims, and it often leaves families wondering how a missing form can erase years of premium payments.
Here is what is really happening behind these denials, and what proof actually helps reverse them.
What Evidence of Insurability Means
Evidence of Insurability, often called EOI, is a medical questionnaire or underwriting form required when an employee elects coverage above the guaranteed issue amount or enrolls late.
The insurer uses it to decide whether to approve the extra coverage.
If the form is never completed or never received, insurers argue that the increased benefit was never approved and therefore never in force.
The problem is that employees are rarely told clearly when EOI is required, and HR departments frequently mishandle the process.
How These Denials Usually Start
Most EOI denials follow the same pattern:
• Employee enrolls in supplemental life insurance
• HR processes enrollment and starts payroll deductions
• No one follows up on missing EOI
• Coverage appears active for months or years
• Employee passes away
• Insurer reviews file and discovers EOI is missing
• Claim is denied
Families are stunned because everything pointed to valid coverage while the insured was alive.
From the insurer’s perspective, the lack of EOI becomes a technical reason to deny after the fact.
Common HR Errors That Lead to These Claims
In many cases, the failure is not the employee’s.
Typical HR mistakes include:
• Never informing the employee that EOI was required
• Failing to provide the EOI form
• Submitting enrollment but not forwarding EOI to the insurer
• Losing paperwork
• Entering coverage in payroll systems before approval
• Confirming coverage to employees without carrier approval
By the time death occurs, the insurer shifts responsibility back to the employee, even though HR controlled the process.
Premium Deductions Matter More Than Insurers Admit
One of the strongest facts in these cases is ongoing premium deductions.
When money is taken from an employee’s paycheck for years, it creates powerful evidence that coverage was treated as active by both the employer and the insurer.
Carriers often argue that payroll errors do not create coverage.
Courts do not always agree, especially when:
• Premiums were consistently deducted
• Coverage appeared on benefit statements
• HR confirmed enrollment
• The employee reasonably believed coverage existed
These facts can support legal arguments based on reliance, waiver, or employer responsibility.
What Proof Helps Beat an EOI Denial
Successful appeals usually depend on documentation that shows the employee did everything they were asked to do, and that the employer treated coverage as approved.
Key evidence includes:
• Enrollment confirmation forms
• Payroll records showing premium deductions
• Benefit summaries listing the coverage amount
• Emails or letters from HR confirming enrollment
• Plan documents explaining the EOI process
• Records showing no notice was given about missing EOI
• Proof the insurer accepted premiums without objection
In many cases, the insurer had years to flag missing EOI and did nothing until a death claim was filed.
That delay matters.
Why ERISA Appeals Are Critical
Most employer sponsored life insurance plans fall under federal ERISA law.
Under ERISA, families usually get only one administrative appeal before the record closes. Any evidence not submitted during that appeal may never be considered by a court later.
This makes early document collection essential.
The appeal is not just paperwork. It is your chance to build the factual record showing that coverage was represented as active and that any missing EOI was caused by HR or administrative failure, not the employee.
Individual Policies Are Different
EOI issues mainly arise in workplace policies. Individually purchased life insurance usually does not involve HR or enrollment systems, although insurers sometimes make similar arguments about incomplete underwriting.
The legal analysis depends heavily on the policy language and payment history.
The Bottom Line
When an insurer denies a claim because HR never submitted Evidence of Insurability, it does not automatically mean coverage was invalid.
These cases often involve administrative breakdowns, employer mistakes, and years of accepted premiums. The real question becomes whether the employee reasonably relied on representations of coverage and whether the insurer had ample opportunity to correct the issue long before a death occurred.
If your claim is denied for missing EOI, do not assume the carrier’s version is final. These denials are frequently challengeable with the right records and a properly built appeal.