Many families are shocked to learn that a group life insurance claim can be denied even though the employee paid premiums and believed coverage was in place. One of the most common reasons insurers give is that the insured was not actively at work at the time coverage supposedly became effective.
These denials almost always surface only after death and frequently involve employer sponsored life insurance plans governed by federal law.
What “Actively at Work” Means in Group Life Policies
Most group life insurance policies require that an employee be actively at work for coverage to take effect or increase. While the exact definition varies by policy, insurers typically argue that actively at work means the employee was:
• Physically present at work
• Performing the regular duties of their job
• Working a minimum number of hours
• Not on medical leave, disability leave, or extended absence
If the insurer claims these conditions were not met, it may deny the death benefit entirely.
Why These Denials Happen After Death
Employees rarely receive notice that coverage never took effect. Employers often deduct premiums automatically, and employees reasonably assume coverage is active.
The issue usually arises only after death, when the insurer reviews employment records and medical history and looks for reasons to deny the claim.
Families often learn for the first time that the insurer is disputing whether coverage ever existed.
Common Scenarios That Trigger Actively at Work Denials
These denials frequently occur when the insured:
• Returned to work briefly after illness
• Worked remotely or on modified duty
• Was on approved medical or family leave
• Had recently increased coverage
• Enrolled during open enrollment while ill
• Was transitioning between roles or schedules
Insurers often take a narrow view of what qualifies as active work.
Why Premium Payments Do Not Stop the Denial
One of the most confusing aspects of these cases is that premiums were paid. Families understandably assume payment equals coverage.
Group life insurance does not work that way. Insurers often argue that premium collection does not override eligibility requirements. They may refund premiums after denying the claim.
That refund does not mean the denial is correct.
Employer Errors That Contribute to These Denials
Many actively at work denials stem from employer mistakes, including:
• Allowing enrollment when eligibility requirements were not met
• Failing to explain coverage conditions
• Incorrectly reporting employment status
• Delayed or inaccurate paperwork
Under federal law, these errors may still leave the insurer liable in certain circumstances.
How ERISA Changes the Fight
Most group life insurance plans are governed by ERISA. That means:
• Strict deadlines apply
• Appeals are mandatory before filing suit
• Evidence must be submitted early
• Courts often defer to plan administrators
Failing to build the administrative record properly can permanently damage the claim.
Challenging an Actively at Work Denial
These denials can be challenged successfully. Key issues often include:
• Whether the policy definition was met
• Whether the insurer applied the rule consistently
• Whether the employee actually performed job duties
• Whether the employer misrepresented eligibility
• Whether the insurer waived the requirement
Medical records, payroll data, supervisor statements, and job descriptions often matter.
Why These Cases Are High Stakes
Group life insurance benefits are often substantial and may be the primary financial protection for a family. An actively at work denial can leave survivors without expected support.
Because these denials occur only after death, families are often under extreme pressure and facing short deadlines.
Take Action Quickly if Coverage Is Disputed
If a group life insurance claim was denied because the insurer claims the insured was not actively at work, do not assume the denial is final. These cases require prompt legal review.
Our firm represents beneficiaries nationwide in denied group life insurance claims and has successfully challenged actively at work denials under ERISA. We offer free case evaluations and do not charge a fee unless benefits are recovered.
If your claim was denied for this reason, contact us before deadlines expire.