FEGLI Claim Denied

FEGLI Life Insurance Claims Denied: Expert Lawyers to Help You Navigate the Process

Our FEGLI life insurance lawyers are here to help you secure the benefits you deserve. Serving all states, we offer a free consultation and no fees unless we win your settlement. If your FEGLI life insurance claim has been denied, it's crucial to understand your rights and the legal avenues available. We specialize in the Federal Employees Group Life Insurance (FEGLI) program, helping you navigate the complexities of federal employee benefits, and we are here to fight for your claim.

What Is FEGLI and Who Is Covered?

The Federal Employees Group Life Insurance (FEGLI) program has been providing life insurance to federal government employees and postal workers since 1954. With over 4 million active and retired federal employees covered, FEGLI is one of the largest group life insurance programs in the country. The program offers four types of coverage options designed to meet varying needs:

Basic Coverage: Provided at no cost for postal workers and available to other federal employees at minimal premiums.
Optional Coverage: Employees can purchase additional coverage through plans A (Standard), B (Additional), and C (Family), giving them flexibility to adjust the coverage based on their needs.

Unlike private life insurance policies, FEGLI is governed by the Federal Employees Group Life Insurance Act (FEGLIA), which supersedes state and federal laws. This makes it essential to understand the regulations and legal precedents that govern claims under this program.

Common Reasons for FEGLI Claim Denials

FEGLI claims can be denied for several reasons, many of which stem from complex regulations. Some of the most common causes of claim denials include:

Invalid or Unspecified Beneficiaries: Disputes or confusion about the designated beneficiaries can result in a denial.
Lack of Documentation: Missing or incomplete forms and insufficient evidence can delay or prevent a claim from being processed.
Failure to Pay Premiums: If premiums are not maintained, the policy may lapse, leading to denial.
Competing Claims: Multiple claimants may file for the same death benefit, leading to disputes and delays.
Ineligible Coverage at Time of Death: Claims may be denied if the deceased employee was not eligible for coverage at the time of their death.

Other specific causes of FEGLI claim denials include exclusions for suicide, self-inflicted harm, and certain war-related injuries. Alcohol and drug-related deaths, as well as some diseases (e.g., bacterial infections, food poisoning), may also be excluded under FEGLI's terms.

Legal Precedents: The Hillman v. Maretta Case

A pivotal case in FEGLI law is the 2013 Supreme Court case Hillman v. Maretta, which emphasized the overriding power of FEGLIA regulations. In this case, the Court ruled that the federal law governing FEGLI takes precedence over state laws that would have granted a new spouse the right to claim life insurance benefits over an ex-spouse. This ruling highlights the importance of understanding federal regulations when dealing with FEGLI claims.

How to Appeal a Denied FEGLI Claim

If your FEGLI claim has been denied, appealing the decision is a critical step. Here’s how to proceed:

Consult a FEGLI Lawyer: An experienced lawyer specializing in FEGLI policies can help you navigate the complex process, ensure compliance with regulations, and investigate the facts surrounding the claim.
Gather Documentation: Ensure all required forms are submitted and that all relevant documentation (death certificates, service records, etc.) is in order to avoid delays.
Legal Precedents: Understanding past legal rulings like Hillman v. Maretta can provide essential guidance in determining your strategy to challenge a denial.
Investigate Policy Details: A lawyer can help you understand the specific terms of the FEGLI policy, including coverage options and exclusions, to build a stronger case for your appeal.

Common Issues Addressed by FEGLI Lawyers

Our FEGLI life insurance lawyers are experts in handling a variety of issues that can arise with federal employee life insurance policies, including:

Beneficiary Designation Problems: Disputes or outdated beneficiary information can result in complications that delay or prevent a claim.
Coverage Amount Discrepancies: Legal challenges may arise regarding the amount of coverage purchased, especially with optional coverage plans.
Accidental Death and Dismemberment Benefits: Issues surrounding accidental death benefits may also require expert legal advice.
Life Event Changes: Major life changes, like marriage, divorce, or children, can impact your coverage options. A lawyer can help you ensure your policy reflects your current circumstances.

Why You Should Work with a FEGLI Life Insurance Lawyer

Navigating FEGLI claims can be difficult without the right expertise. Our FEGLI life insurance lawyers are well-versed in the regulations and legal intricacies that govern the Federal Employees Group Life Insurance Program. If your claim has been denied, it’s essential to get legal help to understand your rights and the next steps in the appeals process.

We offer free consultations and no fees unless we win your settlement, ensuring that you have the support you need at no upfront cost. Our attorneys can guide you through the complexities of FEGLI life insurance policies, ensure all documentation is properly filed, and help you secure the financial support you and your family deserve.

Final Thoughts on FEGLI Life Insurance and Your Rights

FEGLI life insurance offers essential coverage for federal employees and postal workers, providing vital protection for their families. However, understanding the program's regulations and the reasons behind claim denials is crucial. With the assistance of a skilled FEGLI life insurance lawyer, you can navigate the appeal process and ensure that you receive the full benefits you're entitled to. If you’re facing challenges with a denied FEGLI claim, contact us today to schedule your free consultation and begin the path toward securing the benefits you deserve.

CASES

Case 1: Overturning a Denied FEGLI Life Insurance Claim Due to “Failure to Meet Eligibility Requirements”

Ms. Lennox, a widow whose husband, Mr. Harrow, was a federal employee for over 20 years, was devastated when his sudden passing left her to navigate both grief and the complexities of the insurance claim process. Mr. Harrow had been enrolled in FEGLI throughout his career, and Ms. Lennox assumed the life insurance benefits would be easily paid out. However, when she filed the claim, the insurer denied it, claiming that Mr. Harrow’s coverage had lapsed due to an administrative error and that he had not maintained the necessary eligibility for FEGLI at the time of his death.

The insurer argued that Mr. Harrow's coverage had not been updated after his retirement, and as a result, he was no longer eligible for FEGLI benefits. Ms. Lennox was confused because she was certain her husband had kept his policy up to date, and his death occurred less than a year after he retired.

Upon investigation, we uncovered that Mr. Harrow had indeed updated his coverage before his retirement. We found that the error was caused by a miscommunication within the federal agency’s benefits office, which failed to properly forward his information to the insurance provider. We presented documentation proving that Mr. Harrow had properly submitted the necessary paperwork to maintain his FEGLI benefits post-retirement.

We submitted an appeal, including the relevant documents and proof of the agency's administrative oversight. The insurer, after a thorough review, acknowledged the mistake and reversed the decision, providing Ms. Lennox with the full payout. This case highlights the importance of ensuring proper communication between federal agencies and insurance providers, as well as the critical need for careful documentation in ensuring that claims are honored.

Case 2: Challenging a Denied FEGLI Claim Due to “Incorrect Beneficiary Designation”

Ms. Pemberton, the widow of Mr. Dixon, a federal government employee, was shocked when the insurance company denied her claim for FEGLI benefits. The insurer argued that Mr. Dixon’s beneficiary designation had been incorrectly filled out, leading them to deny her claim and instead pay out the benefits to a previous beneficiary listed in the policy.

According to the insurer, Mr. Dixon had failed to update his beneficiary designation after a divorce. They claimed that because his ex-wife was listed as the beneficiary, she was entitled to the payout, even though he had remarried and had been living with his new spouse for over ten years. Ms. Pemberton knew that her husband had updated his beneficiary information after the divorce, but the insurer claimed there was no record of the change.

We immediately initiated an investigation into the situation and discovered that the insurer had failed to process Mr. Dixon’s updated beneficiary designation, despite his having submitted the correct form years prior. We gathered all the necessary paperwork, including a copy of the updated beneficiary designation form, correspondence with the insurance company, and a letter from the agency confirming that the update had been made.

After presenting the evidence in a formal appeal, the insurer reversed its decision and correctly processed the claim, paying out the full FEGLI benefit to Ms. Pemberton. This case underscores the importance of tracking all communications with insurance providers and ensuring that beneficiary information is properly updated and maintained.

Case 3: Contesting a Denied FEGLI Life Insurance Claim Based on “Cause of Death”

Mr. Calloway, a long-time federal employee, passed away unexpectedly from a heart attack at the age of 57. His wife, Mrs. Calloway, filed a claim for the FEGLI life insurance benefits, but the insurer denied the claim. The insurer argued that his cause of death was related to a pre-existing condition that Mr. Calloway had allegedly failed to disclose on his application for life insurance coverage.

Mrs. Calloway was baffled by this decision, as her husband had never been diagnosed with any condition that would have warranted such an exclusion. Mr. Calloway had always been healthy and had no history of heart disease, which led her to believe that the insurer had made a mistake in their assessment of the cause of death.

We conducted a comprehensive review of Mr. Calloway’s medical records and the circumstances surrounding his passing. After consulting with medical experts, we determined that Mr. Calloway’s heart attack was an isolated incident, and there was no pre-existing medical condition that would have warranted an exclusion under the terms of his FEGLI policy. The insurer had mistakenly linked his heart attack to an old diagnosis that had no bearing on the cause of death.

We filed an appeal, providing expert testimony, medical records, and detailed arguments showing that Mr. Calloway’s death was unrelated to any pre-existing condition. After a thorough reexamination, the insurer reversed their denial and paid the full FEGLI benefit to Mrs. Calloway. This case illustrates the importance of challenging insurers when they incorrectly apply policy exclusions.

Case 4: Overturning a Denied FEGLI Life Insurance Claim Due to “Lack of Coverage Continuation after Separation”

Mr. Wentworth, a retired federal employee, passed away after a brief illness. His wife, Mrs. Wentworth, filed a claim for the FEGLI life insurance benefits, only to have it denied on the grounds that his coverage had ended upon separation from service. The insurer claimed that since Mr. Wentworth had been retired for several years and had not elected to continue his FEGLI coverage after his separation, he was ineligible for benefits.

Mrs. Wentworth was dismayed by this decision. She recalled that her husband had been enrolled in FEGLI for many years and had always intended to maintain his coverage throughout his retirement. Upon further review, we discovered that Mr. Wentworth had indeed elected to continue his FEGLI coverage after his retirement, as was allowed under the terms of the policy.

We uncovered that the insurer had mistakenly flagged Mr. Wentworth’s case as one of those who failed to maintain coverage post-retirement. In fact, Mr. Wentworth had completed the necessary forms to continue his coverage, and there had been an administrative error that led to the denial.

We filed a formal appeal with all the supporting documents, including the necessary election forms and proof that the insurer had incorrectly processed the continuation of coverage. After reviewing the evidence, the insurer reversed the denial and issued the full FEGLI benefit to Mrs. Wentworth. This case demonstrates the importance of ensuring that the insurer properly processes post-retirement coverage continuation and how to appeal when there’s an administrative mistake.

Case 5: Contesting a Denied FEGLI Claim Due to “Non-Disclosure of Health Conditions”

Ms. Rojas, the widow of Mr. Thompson, a dedicated federal employee, was left in an incredibly difficult position when the insurance company denied her claim for the FEGLI benefits after her husband's sudden passing. The insurer claimed that Mr. Thompson had failed to disclose pre-existing health conditions on his FEGLI application, which they argued made him ineligible for benefits.

Ms. Rojas was taken aback by the denial, as her husband had no history of significant health problems and had always been in good health. Upon further investigation, we found that Mr. Thompson had been diagnosed with a mild case of asthma in his youth, but this condition had never caused him any significant health issues or required ongoing treatment. The insurer had incorrectly categorized this minor condition as a material omission.

We gathered all medical records, including a letter from Mr. Thompson's primary care physician, which confirmed that his asthma had been well-controlled and did not impact his overall health. We argued that the insurer’s interpretation of the non-disclosure was overly broad and unjustified, given the limited nature of the health condition and the fact that it had never affected his ability to perform his duties.

After filing an appeal and providing the necessary documentation, the insurer reversed their decision, and Ms. Rojas received the full FEGLI benefit. This case highlights the importance of challenging life insurance companies when they attempt to exclude claims based on minor or irrelevant health conditions.

Conclusion: Fighting for Justice in Denied FEGLI Life Insurance Claims

The cases outlined above demonstrate the complexity and persistence needed to successfully challenge denied FEGLI life insurance claims. Whether the denial stems from administrative errors, misinterpretations of policy terms, or incorrect assumptions about health history, each of these cases was successfully overturned by taking a diligent and strategic approach.

FEGLI claims can be complicated, particularly when dealing with the federal bureaucracy and the intricate details of policy terms. It is essential for individuals to carefully review their policies, maintain clear records, and seek professional assistance when facing a denial. If you or a loved one are struggling with a denied FEGLI claim, we are here to help guide you through the process and ensure that your rights are upheld.

Written by: Attorney Christian Lassen, founder of Lassen Law Firm, a national leader in handling life insurance claims, having secured hundreds of millions in settlements for clients nationwide. With 24 years of experience, Mr. Lassen specializes in resolving delayed and denied life insurance claims. He is a certified life member of the Million Dollar Advocates Forum and Multi-Million Dollar Advocates Forum, recognition given only to attorneys who have won million- and multi-million-dollar verdicts and settlements. A top 1% lawyer in the U.S., Mr. Lassen is dedicated to both his clients and community, supporting various charities, especially those focused on children with cancer.

Sources

FEGLI claims may be denied due to lapsed coverage, beneficiary disputes, or issues with eligibility at the time of death. The U.S. Office of Personnel Management (OPM) administers FEGLI and provides guidance on claim procedures and appeal rights. Denials typically include a written explanation, and beneficiaries can request a review. According to OPM guidelines, errors in enrollment records or missing documentation are common reasons for claim denial.