One of the most overlooked reasons for a denied group life insurance claim is the employer’s failure to provide the Summary Plan Description and other plan documents before the denial. Under ERISA, employees and beneficiaries have the right to receive clear, accurate, and timely plan documents that explain eligibility, coverage amounts, exclusions, deadlines, and appeal rights. When employers fail to provide these documents, insurers often deny claims based on rules the family never had a chance to see.
This denial tactic is becoming more common because it shifts responsibility away from the insurer and onto the employer. Families are told the insured was ineligible, missed a deadline, or failed to complete a requirement, even though the employer never provided the documents that would have explained those obligations.
This guide explains how employers mishandle plan documents, how insurers use those failures to deny claims, and how beneficiaries can challenge these denials.
Why the SPD and Plan Documents Matter
The Summary Plan Description is the roadmap for the entire group life insurance plan. It explains:
• Eligibility rules • Enrollment requirements • Evidence of insurability rules • Coverage amounts • Grace periods • Conversion and portability rights • Appeal deadlines • Notice requirements
Employees rely on the SPD to understand what they must do to maintain coverage. When employers fail to provide it, employees cannot comply with rules they never saw.
How Employers Fail to Provide Required Documents
Employers often mishandle plan documents in predictable ways. Common failures include:
• Never giving the employee an SPD at hire • Failing to provide updated SPDs after plan changes • Not providing the SPD during open enrollment • Not giving beneficiaries the SPD after death • Providing only marketing brochures instead of the actual plan • Giving outdated or incorrect versions of the plan • Failing to provide the certificate of coverage • Ignoring written requests for plan documents
These failures leave employees and families in the dark about their rights.
How Insurers Use Missing Documents to Deny Claims
When a claim is filed, insurers rely on the plan documents to justify a denial. They may argue:
• The insured was not eligible for coverage • The insured failed to complete evidence of insurability • The insured was not actively at work • The insured missed the conversion deadline • The insured’s coverage ended during leave • The insured’s supplemental coverage was never approved
The problem is that the insured never received the documents that explained these requirements. Insurers deny the claim anyway, claiming the rules were clear even when they were never provided.
Why These Denials Are Often Improper
Under ERISA, employers must provide plan documents upon request and must distribute SPDs within strict timelines. When they fail to do so, the denial may be invalid.
Here are the most common reasons these denials collapse.
The employee never received the SPD
If the employer cannot prove the SPD was provided, the employee cannot be held responsible for unknown requirements.
The employer provided the wrong version of the plan
Many denials rely on outdated or incorrect documents.
The SPD conflicts with the certificate of coverage
If documents conflict, courts often rule in favor of the insured.
The employer failed to notify the employee of required steps
Employees cannot comply with rules they were never told about.
The insurer relied on rules that were never disclosed
Undisclosed requirements cannot be used to deny benefits.
How Beneficiaries Can Challenge These Denials
These denials are highly challengeable because they depend on strict ERISA disclosure rules that employers frequently violate.
Beneficiaries should take the following steps.
Request the complete claim file
The claim file will show which documents the insurer relied on and whether the employer provided them.
Demand all plan documents from the employer
Employers must provide:
• SPD • Certificate of coverage • Master policy • Enrollment forms • Eligibility rules • Evidence of insurability requirements
Failure to provide these documents can support the appeal.
Compare the documents to the denial reason
Many denials rely on rules that do not appear in the SPD.
Look for inconsistencies between documents
Conflicts between the SPD and certificate often favor the insured.
Examine whether the employee was ever notified of requirements
If the employer never communicated a requirement, the denial may be invalid.
When the Denial Becomes Bad Faith or an ERISA Violation
A denial may cross into misconduct when the employer or insurer:
• Fails to provide required documents • Provides outdated or incorrect documents • Relies on rules not disclosed in the SPD • Ignores written requests for plan documents • Applies requirements the employee never saw • Uses missing documents to justify a denial
These failures can support additional remedies under ERISA.
Why Families Should Not Give Up
When employers fail to provide the SPD or plan documents, beneficiaries are not bound by undisclosed rules. Insurers often rely on employer mistakes to deny claims, but these denials frequently collapse once the disclosure failures are exposed.
Families should not accept a denial based on eligibility or procedural requirements without confirming that the employer provided the correct documents.