We are happy to announce the resolution of a $20,000 denied life insurance claim.
Why do life insurance claims through work fall under ERISA, and what are some differences between denied ERISA life insurance claims and regular life insurance claims?
Life insurance claims through work fall under the Employee Retirement Income Security Act (ERISA) because ERISA governs employee benefit plans, including group life insurance plans provided by employers. ERISA sets minimum standards for employee benefit plans, including disclosure and reporting requirements, fiduciary duties, and claims procedures.
Here are some potential differences between denied ERISA life insurance claims and regular life insurance claims:
- Time constraints: ERISA has strict time constraints for filing and appealing denied life insurance claims, which are generally shorter than those for regular life insurance claims.
- Standard of review: Under ERISA, courts review denied life insurance claims using an "abuse of discretion" standard, which gives deference to the insurance company's decision. In contrast, regular life insurance claims are reviewed using a "de novo" standard, which allows the court to consider new evidence and make an independent determination.
- Required exhaustion of administrative remedies: Under ERISA, claimants must exhaust all administrative remedies before filing a lawsuit, which means that they must go through the insurance company's internal appeals process before filing a lawsuit. This requirement does not apply to regular life insurance claims.
- Limited discovery: Discovery is the process of gathering evidence in a lawsuit. Under ERISA, discovery is limited, which can make it more difficult to obtain evidence to support a denied life insurance claim.
- No right to a jury trial: Under ERISA, claimants do not have the right to a jury trial, while they do have this right in regular life insurance claims.
- Limited damages: Under ERISA, damages are limited to the amount of the denied benefits, while in regular life insurance claims, damages may include compensatory and punitive damages.
- Preemption of state law: ERISA preempts state law, which means that state law claims, such as breach of contract or bad faith, may not be available in denied ERISA life insurance claims.
- Administrative record: Under ERISA, the court generally considers only the administrative record, which is the evidence that was presented to the insurance company during the claims process. In regular life insurance claims, the court may consider new evidence.
- Burden of proof: The burden of proof in denied ERISA life insurance claims is on the claimant, while in regular life insurance claims, the burden of proof may be on the insurance company.
- Statutory penalties: Under ERISA, there may be statutory penalties for failure to comply with the claims procedures, while there are no such penalties in regular life insurance claims.
If you have a denied life insurance claim or a life insurance beneficiary dispute, our life insurance lawyers will fight and win.