How to Fight an ERISA Life Insurance Claim Denial
Few things are more emotionally draining than losing a loved one and then having to battle an insurance company over a denied life insurance claim. If that denial involves an ERISA life insurance policy—a plan governed by the Employee Retirement Income Security Act—the frustration can be even worse. These policies are typically offered through an employer, and they come with a unique set of rules, procedures, and legal challenges. It may feel like the insurer is hiding behind red tape, hoping you'll give up. But you don’t have to.
What Is an ERISA Life Insurance Policy?
ERISA was created to set standards for employer-sponsored benefits, including group life insurance. If your loved one received their policy through work, chances are it falls under this federal law. But not all ERISA life insurance plans are the same. Each company’s plan can have its own rules for eligibility, coverage, exclusions, and—most importantly—what you need to do if your claim gets denied.
Because of ERISA’s strict administrative process, you don’t automatically get your day in court. You must first go through the insurance company’s internal appeals process. If you miss a step or miss a deadline, your case could be over before it ever begins.
Step One: Get the Full Policy and Plan Documents
The first and most critical move is to request all plan documents in writing. This includes the actual insurance policy, any plan summaries, amendments, and denial letters. These documents spell out your rights, the insurer’s obligations, and the steps you must take to challenge the denial.
Unfortunately, many claimants don’t realize how important this step is until it’s too late. Without these documents, you may be navigating blind. And in ERISA cases, you only get one chance to build your administrative record—so you need to get it right.
Step Two: Understand the Reason for the Denial
Insurance companies often deny ERISA claims based on alleged misrepresentations, missed premium payments, or exclusions buried in the fine print. The denial letter must tell you why the claim was rejected, but that explanation can be vague or even misleading.
An experienced ERISA life insurance attorney can review the policy language, the denial letter, and the relevant facts to determine whether the insurer acted improperly. Sometimes, claims are denied over minor technicalities that have little to do with the actual cause of death. Other times, the insurer may misapply their own rules—or fail to follow ERISA’s procedural requirements.
Step Three: File a Timely and Thorough Appeal
Under ERISA, you usually have 180 days to file an internal appeal. This is your only opportunity to submit evidence, medical records, affidavits, and legal arguments. Once the appeal is closed, you can’t introduce new information—even if the case ends up in federal court.
That’s why legal help is so important. A skilled ERISA attorney can help you build a comprehensive appeal that maximizes your chances of success before litigation becomes necessary. A weak appeal can doom your case, but a strong one can often lead to a reversal of the denial.
Why You Shouldn’t Go It Alone
ERISA law is notoriously complex. There’s no jury trial, limited discovery, and the court typically reviews only the administrative record. In other words, it’s not a level playing field. Insurance companies know this—and they bank on people giving up.
But you don’t have to be one of those people. With the right help, many denied ERISA life insurance claims can be overturned. Whether your case involves a supposed lapse in coverage, a dispute over the cause of death, or a misrepresentation allegation, legal guidance can make all the difference.
We’re Here to Help
If your ERISA life insurance claim has been denied, don’t wait until it’s too late to act. Our team of experienced life insurance attorneys understands the ins and outs of ERISA and is ready to step in and fight for you. This isn’t just about a payout—it’s about justice, closure, and protecting your loved one’s legacy. The insurance company may treat it like just another file on their desk. We won’t.
Contact us today for a free consultation. Let’s take the first step together toward securing the benefits you’re rightfully owed.