If a life insurance claim under an employer-sponsored policy is denied or delayed, time is not on your side. Most workplace life insurance plans are governed by the Employee Retirement Income Security Act of 1974, commonly known as ERISA. This federal law controls how claims must be handled, how appeals must be filed, and what rights beneficiaries actually have once a denial occurs.
One of the most important ERISA protections, and also one of the most dangerous traps, is the appeal deadline. In most cases, beneficiaries have only 60 days from the date of the denial letter to submit a written appeal. Missing that deadline can permanently destroy your right to recover benefits, regardless of how strong the underlying claim may be. Because ERISA imposes strict procedural requirements, early legal guidance is not optional. It is often the difference between recovery and a total loss.
How ERISA Changes the Rules of Life Insurance Claims
ERISA applies to most private-sector employer-provided life insurance policies. These plans operate under federal law, not state insurance law. That distinction matters because ERISA limits what beneficiaries can do and how disputes can be resolved.
Unlike individually purchased life insurance policies, ERISA-governed plans require that all internal appeals be completed before any lawsuit can be filed. This is not a technical step. It is the legal foundation of the case. If the appeal is not filed properly, or if required issues are not raised during the appeal, courts will not allow those issues to be argued later.
Even more importantly, once the appeal process ends, the record closes. Courts reviewing ERISA cases generally look only at the administrative record. New evidence is not allowed. No additional documents. No new testimony. No second chance to clarify mistakes.
Why the Appeal Stage Is the Most Important Phase
Once a denial letter is issued, insurers often become less cooperative. At that point, they know ERISA limits your remedies and removes many forms of legal pressure. The short appeal window creates urgency, but it also creates leverage for insurers who assume beneficiaries will either miss the deadline or submit an incomplete appeal.
A properly constructed ERISA appeal does far more than ask for reconsideration. It preserves legal arguments, forces the insurer to justify its decision, and builds the exact record a judge will later review. An appeal that lacks detail or supporting documentation may satisfy the deadline, but still fail to protect your rights.
Employer Fiduciary Duties and Administrative Failures
Many ERISA life insurance denials are caused by employer errors rather than wrongdoing by the insured. Employers and plan administrators are fiduciaries under ERISA. That means they are legally required to act prudently and in the best interests of plan participants.
Common employer-related failures include improper enrollment, failure to submit premiums, incorrect eligibility determinations, and misinformation about coverage continuation. When an employer’s mistake causes a loss of coverage, ERISA allows beneficiaries to pursue claims based on breach of fiduciary duty.
In many cases, employers carry fiduciary liability insurance that may cover these errors. This creates an additional recovery path beyond the insurer itself. Identifying and preserving these claims requires careful review of plan documents, payroll records, and internal communications.
Limits ERISA Places on Beneficiaries
While ERISA provides certain protections, it also restricts remedies. Beneficiaries cannot sue for bad faith. Punitive damages are not available. Jury trials are not permitted. Judges decide cases based on the administrative record and the terms of the plan.
Because ERISA preempts most state law claims, beneficiaries cannot rely on breach of contract theories or consumer protection statutes that might otherwise apply. The entire dispute unfolds within a narrow federal framework where procedure matters as much as substance.
Common Employer-Based Denial Scenarios
Employer-sponsored life insurance claims are frequently denied for reasons unique to workplace plans, including:
• The insured was no longer actively employed at the time of death
• Minimum hour requirements were not met
• Coverage was not converted after employment ended
• Eligibility was lost during unpaid or medical leave
• Status changes were not reported to the insurer
• AD&D benefits were reduced or excluded without clear disclosure
• Premiums were not paid due to payroll or administrative errors
• Death occurred during military service or another excluded activity
These situations often involve conflicting records and unclear communication. When employers fail to meet their fiduciary obligations, liability can shift away from the beneficiary entirely.
Why Legal Representation Matters in ERISA Claims
ERISA does not forgive mistakes. Courts strictly enforce deadlines, record limits, and procedural rules. Beneficiaries who attempt to handle appeals on their own often unknowingly waive arguments or fail to submit critical evidence in time.
An attorney experienced in ERISA life insurance claims knows how to obtain the full administrative file, demand internal claim handling guidelines, and identify violations that strengthen the case. This includes recognizing inconsistent interpretations of plan language, selective evidence review, and procedural irregularities that courts take seriously.
Many firms handle ERISA life insurance cases on a contingency basis, meaning there are no upfront legal fees. The earlier counsel becomes involved, the better positioned you are to protect deadlines, preserve evidence, and enforce your rights under federal law.