Supplemental group life insurance denials often surprise beneficiaries because they come long after everyone believed coverage was in place.
The employee enrolled. Payroll deductions were taken. Coverage amounts appeared on benefit statements. Then, after death, the insurer claims that evidence of insurability was never approved.
From the insurer’s perspective, this is a clean denial.
From a legal perspective, it is often anything but.
What evidence of insurability actually means
Evidence of insurability, often shortened to EOI, is a health review requirement used when an employee elects supplemental life insurance above a guaranteed issue amount.
It may involve:
Health questionnaires
Medical records
Attestations about medical history
Sometimes exams or follow-up requests
The key point is timing. Evidence of insurability is supposed to be evaluated when coverage is elected, not years later after a claim is filed.
How these denials usually surface
Most beneficiaries first learn about an EOI problem in the denial letter itself.
Common insurer explanations include:
The insured never submitted EOI
The EOI was incomplete
The EOI was submitted but never approved
The employer failed to forward paperwork
The insured was never eligible for the elected amount
Often, no one raised these issues while premiums were being deducted.
Payroll deductions are the core problem for insurers
One of the biggest weaknesses in EOI denials is premium acceptance.
When insurers and employers deduct premiums for supplemental coverage, they are representing that coverage exists.
Insurers later try to reframe this as a clerical error or employer mistake. Courts are often skeptical, especially when deductions continued for months or years.
Coverage cannot exist only when it benefits the insurer.
Employer involvement complicates EOI denials
Group life insurers frequently blame employers.
You may see language like:
HR failed to submit forms
Enrollment systems did not flag EOI requirements
The employer misrepresented coverage amounts
The insured selected coverage without approval
That finger pointing does not automatically defeat a claim.
Many courts recognize that employees reasonably rely on employer benefit systems and representations, particularly in ERISA governed plans.
ERISA makes early appeals critical
Most supplemental group life policies are governed by ERISA. That changes everything.
Under ERISA:
The administrative record controls the case
New evidence is often barred later
Appeal deadlines are strict
Silence can be treated as acceptance of the insurer’s framing
EOI denials are often won or lost at the appeal stage, not in court.
If the appeal does not challenge payroll deductions, employer conduct, and insurer delay, the denial hardens.
Red flags that suggest the denial is vulnerable
EOI denials deserve closer scrutiny when:
Premiums were deducted consistently
Benefit statements listed the higher coverage amount
No EOI request was ever communicated
The insurer waited until after death to raise the issue
The employer confirms the employee enrolled correctly
These facts often undermine the insurer’s narrative that coverage never existed.
Why insurers prefer EOI denials after death
From an insurer’s perspective, EOI denials are attractive.
They avoid arguing misrepresentation.
They avoid contestability rules.
They avoid medical causation fights.
Instead, the insurer claims there was simply no coverage.
That simplicity disappears when conduct and reliance are examined.
How these cases are typically challenged
Successful challenges usually focus on process failures, not health conditions.
Common arguments include:
Waiver through premium acceptance
Estoppel based on employer and insurer representations
Failure to timely request or process EOI
Inconsistent treatment of coverage status
ERISA procedural violations
These cases are rarely about whether the insured was healthy enough. They are about whether the insurer and employer followed their own rules.
Why beneficiaries should not accept these denials at face value
EOI denials sound definitive. They are often presented as non-negotiable.
In reality, they frequently rest on administrative breakdowns that insurers hope beneficiaries will not question.
Once challenged properly, many of these denials unravel.