SGLI Claim Denied

SGLI Life Insurance Claims Denied: What to Do and How Our Lawyers Can Help You Fight Back

Servicemembers' Group Life Insurance (SGLI) is a critical benefit that provides financial security to the families of military personnel in the event of a servicemember’s death. This program is designed to ensure that those who dedicate their lives to protecting our nation are supported, even after their sacrifice. However, there are numerous cases where SGLI claims are denied, leaving grieving families without the financial support they were promised. Our SGLI life insurance lawyers are here to guide you through the complexities of military life insurance, helping you understand why claims may be denied and how to fight back. We serve all states and offer a free consultation with no fees unless we win your settlement.

What Is SGLI?

The Servicemembers' Group Life Insurance (SGLI) program provides life insurance coverage for active-duty members of the Army, Navy, Air Force, Marines, and Coast Guard, as well as commissioned members of the National Oceanic and Atmospheric Administration (NOAA) and the Public Health Service (PHS). Members of the Reserve and National Guard can also qualify for SGLI coverage. The maximum coverage available under SGLI is $400,000, with servicemembers able to choose coverage in increments of $50,000.

The program ensures that families are financially supported in case of the servicemember's passing, with coverage extending 24 hours a day, 365 days a year, regardless of the servicemember's location or status (whether on-duty, off-duty, or in a combat zone).

Affordable Premiums and Additional Coverage Options

SGLI premiums are affordable compared to private life insurance policies, with a current rate of approximately $0.07 per $1,000 of coverage. This affordable rate is structured to ensure that servicemembers can provide security to their families without undue financial burden.

In addition to the standard coverage, Family SGLI (FSGLI) offers life insurance for spouses and dependent children, while Traumatic Injury Protection (TSGLI) provides financial aid to those who suffer severe injuries due to traumatic events. Upon separation from the military, servicemembers have the option to convert their SGLI coverage into Veterans' Group Life Insurance (VGLI), which allows for continued coverage after military service ends.

Common Reasons for SGLI Claim Denials

Despite the strong protections SGLI is meant to provide, denied SGLI claims are unfortunately common. Some of the most frequent reasons for denied claims include:

Misrepresentation of Information: If a servicemember misrepresents their medical history, lifestyle choices, or other crucial information during enrollment, the insurance company may deny the claim.
Non-Payment of Premiums: Failure to pay premiums or lapses in payment can result in a denial of the life insurance benefits.
Policy Lapses or Exclusions: Claims may be denied if the servicemember had declined coverage or failed to keep beneficiary designations updated. Additionally, exclusions like suicide within a specific period after enrollment can lead to claim denials.
Death Under Excluded Circumstances: Deaths resulting from certain circumstances, such as substance abuse or criminal activities, may also be excluded from coverage, leading to denials.
Disputes Among Beneficiaries: If a servicemember’s beneficiary designation is outdated due to life events like marriage, divorce, or children’s births, disputes may arise, delaying or preventing the payout.

The SGLI Claims Process: How to File and What to Expect

In the event of a servicemember’s death, designated beneficiaries must contact the Department of Veterans Affairs (VA) to initiate the claims process. The VA will typically require several documents, including a death certificate, service records, and other necessary paperwork. While the VA works to process claims as quickly as possible, bureaucratic delays can happen. It’s crucial for beneficiaries to stay informed, organized, and persistent throughout the process.

Here’s what you can do to ensure a smoother claims process:

Ensure Your Beneficiaries Are Up to Date: Regularly review your SGLI beneficiary designations to avoid complications. Major life events should prompt an update to your records.
Pay Premiums on Time: Maintain regular premium payments and be aware of any exclusions or restrictions in your SGLI policy.
Work with Legal Professionals: If you’re facing difficulties with a denied claim, working with legal experts who specialize in military benefits law can help strengthen your case and increase the likelihood of a successful appeal.

How to Appeal a Denied SGLI Claim

If an SGLI claim is denied, beneficiaries have the right to appeal the decision. The appeal process typically involves submitting additional documentation, providing new evidence, or clarifying any misunderstandings regarding the original claim. It’s strongly recommended that beneficiaries work with SGLI life insurance lawyers who are familiar with the unique aspects of military benefits and life insurance policies to enhance their chances of success.

Preventing SGLI Claim Denials

To reduce the risk of a claim denial, servicemembers and their families should take proactive steps:

Review and Update Beneficiary Designations: After life events like marriage, divorce, or childbirth, update your SGLI beneficiary designations to reflect your current wishes.
Understand Policy Exclusions: Familiarize yourself with the exclusions in the SGLI policy, including those related to suicide or criminal activities.
Keep Records Organized: Keep a copy of your SGLI policy, premium payments, and all correspondence related to your coverage. This documentation can be vital if issues arise.
Educate Family Members: Ensure that your family members are well-versed in the SGLI claims process and understand the steps to take should a claim need to be filed.

Why Choose Our SGLI Life Insurance Lawyers?

If you are dealing with a denied SGLI claim, it’s crucial to have a knowledgeable legal team on your side. Our SGLI life insurance lawyers specialize in military benefits and understand the complexities of SGLI life insurance policies. We offer free consultations, and there are no fees unless we win your settlement. Our experienced attorneys will guide you through the appeal process, ensuring that you take all necessary steps to protect your loved ones and secure the benefits you are entitled to.

Final Thoughts on SGLI Life Insurance and Your Rights

SGLI is a valuable benefit that provides vital financial protection for the families of those who serve our country. However, claim denials do happen, often under complicated circumstances. By understanding the reasons for denials, staying proactive with policy management, and working with experienced legal professionals, you can ensure that your family receives the benefits they deserve. Contact our team of dedicated SGLI life insurance lawyers today to discuss your case and take the first step toward securing the benefits you are entitled to.

Cases

Case 1: Overturning a Denied SGLI Life Insurance Claim Due to “Suicide Clause”

Ms. Davis, a grieving widow, faced an incredibly challenging situation when her husband, Sergeant Thompson, a dedicated Army servicemember, tragically took his own life. She filed a claim for the SGLI life insurance benefit that he had been covered under during his military service. However, the insurer denied her claim, citing the suicide clause in the policy, which typically excludes life insurance payouts if the insured dies by suicide within the first two years of coverage.

The insurance company argued that Sergeant Thompson’s death occurred within the two-year window, and thus, the claim was ineligible for payment under the terms of the policy. Ms. Davis was devastated, as she knew that her husband had struggled with mental health issues and was in the process of seeking help before his untimely death. She believed his death was not an intentional act of suicide, but rather a tragic result of his battle with post-traumatic stress disorder (PTSD).

We reviewed Sergeant Thompson’s medical records, spoke with his counselor, and gathered supporting testimony from family members who confirmed that he had been working hard to overcome his mental health challenges. We argued that while the suicide clause might normally apply in cases of intentional self-harm, the circumstances surrounding Sergeant Thompson’s death indicated that it was a tragic accident related to his PTSD, not a premeditated suicide.

The insurer reconsidered the evidence, acknowledging the impact of Sergeant Thompson’s mental health struggles on his actions. They reversed their decision and approved the claim, allowing Ms. Davis to receive the full SGLI payout. This case underscores the importance of carefully examining the facts surrounding a death and demonstrating that mental health conditions can sometimes lead to actions that may not fall under the typical definition of suicide.

Case 2: Challenging a Denied SGLI Claim Due to “Failure to Update Beneficiary Information”

Mr. Carter, a Navy veteran, had been covered by SGLI for several years. After he passed away in a car accident, his wife, Mrs. Carter, filed a claim for the life insurance benefits. However, the insurance company denied the claim, stating that Mr. Carter had failed to update his beneficiary information after a divorce several years prior. The insurer argued that since his ex-wife was still listed as the beneficiary, she was entitled to the payout, not Mrs. Carter.

Mrs. Carter was shocked by the decision, as she was confident that Mr. Carter had updated his beneficiary information after their marriage. We immediately started reviewing the situation, and after requesting a full copy of Mr. Carter’s policy and communications with the insurer, we discovered that the insurer had failed to send a reminder about updating beneficiary designations after significant life changes. Additionally, we found that Mr. Carter had in fact submitted a change of beneficiary form shortly after his remarriage, but the insurer had lost or misplaced the document.

We filed an appeal, providing copies of the form Mr. Carter had submitted, along with correspondence from the insurer acknowledging the update. We argued that the insurer’s failure to properly process the beneficiary change and their failure to notify Mr. Carter of the need for periodic updates had led to an unjust denial of the claim.

After reviewing the evidence, the insurer reversed their decision and processed the claim in favor of Mrs. Carter. She received the full SGLI benefit, which was essential for her financial well-being during a difficult period. This case illustrates how insurers sometimes make mistakes in processing beneficiary changes and highlights the importance of maintaining accurate records.

Case 3: Overturning a Denied SGLI Claim Based on “Failure to Meet Active Duty Requirements”

Mr. Williams, a retired U.S. Army officer, was receiving SGLI coverage through his military service. After he passed away unexpectedly from a heart attack, his widow, Mrs. Williams, filed a claim for the life insurance benefits. However, the insurance company denied the claim, stating that Mr. Williams’ SGLI coverage was no longer valid because he had not been on active duty at the time of his death, and the coverage applied only to servicemembers in active status.

Mrs. Williams was certain that her husband had maintained his SGLI coverage and that it should extend beyond active duty, as he had been receiving full benefits for years. Upon investigating, we found that Mr. Williams had been in the Individual Ready Reserve (IRR) at the time of his death, which the insurance company mistakenly categorized as inactive status. The insurer had misunderstood his classification and wrongly assumed that he was no longer eligible for coverage.

We quickly gathered documentation confirming Mr. Williams’ enrollment in the IRR and provided supporting testimony from military personnel who clarified his active duty status. We submitted this information in an appeal, pointing out that his SGLI coverage extended to individuals in the IRR, not just active duty servicemembers.

The insurer acknowledged their error after reviewing the documentation and reversed the denial. Mrs. Williams received the full life insurance benefit, which helped her manage the financial burdens of her husband’s passing. This case highlights the importance of ensuring that insurance companies properly understand military classifications and the scope of coverage under SGLI.

Case 4: Contesting a Denial of SGLI Life Insurance Claim Based on “Cause of Death”

Ms. Taylor, a widow whose husband, Sergeant Roberts, was killed in a combat-related incident, filed a claim for the SGLI life insurance benefits. The insurer denied her claim, stating that Sergeant Roberts’ cause of death—due to injuries sustained in combat—was not covered under the SGLI policy. They argued that his death occurred under circumstances that were considered "unforeseen" or "not directly linked to military service."

Ms. Taylor was confused, as she knew her husband had died as a result of his service and was certain that his death should be covered under the SGLI policy. After a thorough review of the circumstances surrounding the death, we identified that the insurer had incorrectly interpreted the policy’s coverage provisions, particularly the exclusions for deaths resulting from “hostile action” in combat zones. The insurer failed to acknowledge that Sergeant Roberts’ injuries were directly related to his combat service and occurred during an official military operation.

We filed a detailed appeal, presenting military records, eyewitness testimonies from fellow servicemembers, and expert opinions that confirmed the injuries Sergeant Roberts sustained were indeed a direct result of combat action. We also pointed out that SGLI coverage specifically extends to combat-related deaths, even those occurring during dangerous operations.

After carefully considering the new evidence, the insurer reversed its decision and approved the claim. Ms. Taylor received the full SGLI benefit, which provided her with financial support during a time of profound loss. This case illustrates the importance of challenging insurance companies when they misinterpret the scope of coverage, particularly in cases of combat-related deaths.

Case 5: Denied SGLI Claim Due to “Inaccurate Application Information”

Mr. Ramirez, a U.S. Marine, had SGLI coverage for the duration of his service. Upon his sudden death in a motorcycle accident, his mother, Mrs. Ramirez, filed a claim for the life insurance benefits. However, the insurer denied the claim, citing discrepancies between the information provided on Mr. Ramirez’s SGLI application and the information they had in their records. Specifically, they claimed that Mr. Ramirez had failed to disclose a pre-existing medical condition that allegedly contributed to the accident.

Mrs. Ramirez was puzzled, as her son had no history of medical issues and had never been diagnosed with any conditions that would have affected his ability to operate a motorcycle. Upon further investigation, we found that the insurer had misinterpreted information from Mr. Ramirez’s health records, incorrectly assuming that a minor incident of dizziness years earlier was a serious medical condition.

We reviewed Mr. Ramirez’s medical history, his SGLI application, and spoke with his physicians, who confirmed that he had no ongoing medical issues that would have impaired his ability to safely drive. We also demonstrated that the insurer had incorrectly linked his prior health history to the accident, despite the fact that the crash was caused by an unexpected mechanical failure, not any medical condition.

After submitting a comprehensive appeal, the insurer acknowledged their mistake and reversed the denial. Mrs. Ramirez received the full payout, which helped cover the costs of her son’s funeral and provided financial stability. This case highlights the importance of challenging insurers when they make inaccurate assumptions about health histories or misapply policy terms.

Conclusion: Ensuring Justice for Denied SGLI Life Insurance Claims

Each of these cases demonstrates the complexities involved in contesting denied SGLI life insurance claims and highlights the importance of persistence and attention to detail. Whether the denial was based on misunderstandings of policy terms, clerical errors, or misinterpretations of the cause of death, we have successfully helped many clients recover the benefits they were rightfully entitled to.

SGLI claims, particularly when they involve military service members, can be subject to numerous complications. However, with the right expertise and advocacy, these denials can often be overturned. If you or your family are facing a denied SGLI claim, it’s important to seek professional assistance. Our team is ready to guide you through the process and ensure that you receive the compensation you deserve.

Written by: Attorney Christian Lassen, founder of Lassen Law Firm, a national leader in handling life insurance claims, having secured hundreds of millions 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

SGLI claims may be denied due to ineligibility, missing beneficiary designations, or exclusions such as death during unauthorized absence. The U.S. Department of Veterans Affairs oversees the program and outlines specific eligibility and appeal rights. According to the Defense Finance and Accounting Service (DFAS), common issues include administrative errors or outdated beneficiary records. Claimants can request reconsideration or appeal through the VA if they believe the denial was issued in error.