Our FEGLI life insurance lawyers are happy to announce a $372,000 claim successfully resolve.
FEGLI is a group life insurance program offered to federal employees and retirees. It provides basic life insurance coverage as well as optional coverage such as Additional FEGLI (Option B), and Family FEGLI (Option C) for eligible family members. The lawyers LifeInsuranceAttorney.com handle denied FEGLI claims and FEGLI life insurance beneficiary disputes.
When it comes to filing claims under FEGLI, it typically involves the following steps:
- The beneficiary or the person entitled to the benefits must notify the Office of Federal Employees' Group Life Insurance (OFEGLI) of the insured person's death. This notification usually initiates the claims process.
- Claim Form Submission: OFEGLI provides claim forms that need to be filled out by the beneficiary or the designated person. The form usually requires basic information about the deceased, the beneficiary, and details about the insurance policy.
- Along with the claim form, certain documents might be required to support the claim. This may include a certified copy of the death certificate, proof of relationship to the insured, and any other relevant paperwork.
- Review and Processing: Once the claim form and supporting documents are submitted, OFEGLI reviews the claim to ensure that it meets all the requirements for payment. This includes verifying the policy details, the cause of death, and the eligibility of the beneficiary.
- If the claim is approved, OFEGLI disburses the death benefits to the designated beneficiary or beneficiaries.
Denied FEGLI claims can occur for various reasons, including:
- Failure to Meet Eligibility Requirements:
- FEGLI coverage is available to eligible federal employees, retirees, and their eligible family members. If the insured individual was not eligible for FEGLI coverage at the time of their death, the claim may be denied. Eligibility criteria can vary depending on factors such as employment status, length of service, and enrollment in the FEGLI program.
- Lapsed Policy:
- FEGLI coverage requires regular premium payments to remain active. If the policyholder fails to pay premiums on time, the policy may lapse, resulting in loss of coverage. In such cases, if the insured individual passes away after the policy has lapsed, the claim may be denied.
- Misrepresentation or Fraud:
- If it's discovered that there was material misrepresentation or fraud involved in obtaining the FEGLI coverage, the claim may be denied. This could include providing false information about health conditions or employment status during the enrollment process.
- Cause of Death Not Covered:
- FEGLI policies typically have exclusions for certain causes of death. If the insured individual's death resulted from activities excluded from coverage (e.g., participating in high-risk hobbies or illegal activities), the claim may be denied. Additionally, if the death falls within the policy's suicide clause period (usually within the first two years of coverage), the claim might be denied.
- Failure to Provide Required Documentation:
- When filing a claim, certain documentation is typically required to support the claim, such as a certified copy of the death certificate, proof of relationship to the insured, and any other relevant paperwork. If the necessary documents are not provided or if there are discrepancies in the information provided, the claim may be denied or delayed.
- Non-Compliance with Policy Terms:
- FEGLI policies have specific terms and conditions that policyholders must adhere to. Failure to comply with these terms, such as failing to notify the insurer of changes in personal information or failing to report certain events as required by the policy, could result in a denied claim.
- Beneficiary Disputes:
- If there are disputes or discrepancies regarding the designation of beneficiaries, the claim may be delayed or denied until the issue is resolved. This could occur if there are multiple claimants asserting rights to the benefits or if there is uncertainty about the validity of the beneficiary designation.
- Policy Exclusions and Limitations:
- FEGLI policies may have specific exclusions and limitations outlined in the policy documents. If the circumstances of the insured individual's death fall within these exclusions or limitations, the claim may be denied.
In the event of a denied claim, the beneficiary typically has the right to appeal the decision and provide additional evidence or clarification to support their claim.
It's essential that you NOT try to appeal your FEGLI claim yourself, as they only allow one appeal. Our top FEGLI life insurance lawyers will get you the money to which you are entitled.