Erisa Claim Denials Group Life Insurance

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Strict and complex state and federal laws govern employer-provided life insurance. Despite heavy regulation, the claims of beneficiaries of group life insurance are often improperly denied.

Having represented thousands of beneficiaries whose claims were delayed or denied, we have found that employers or life insurance companies often run afoul of those laws, causing a lapse in coverage and improper denial of beneficiaries’ claims.

If your claim was denied, but the insured should have been eligible for life insurance disability waiver of premiums, we can help appeal denial of your life insurance claim and get you paid.

For the insured, if you have become disabled and your life insurance company denies your request for a waiver of premium payments, you must file an appeal under ERISA.

For a beneficiary, if your claim was denied due to lapse in coverage caused by non-payment of premiums, you should call us at 1-855-240-9160. It may be that the employer wrongfully ceased paying premiums on behalf of the insured or improperly handled the insured’s request for waiver of premium payments, or the insurance company mishandled the waiver request or improperly denied it. We will find out for you.

These are two of the most common reasons a life insurance claim is denied. In either case, you need an experienced and diligent life insurance attorney by your side to fight for your rights under the employer group life insurance policy and the Employee Retirement Income Security Act of 1974 (ERISA). Give us a call to schedule your free, no-obligation, no-risk consultation. We never get paid unless you do.

We are the Life Insurance Lawyers

What Does Life Insurance Waiver of Premium Mean?

Life insurance coverage usually only continues as long as the premiums are paid. However, a person who is disabled and unable to work may be entitled to continuing coverage under the employer’s group life insurance plan and have the premium payments waived during the period of disability.

Most group life insurance policies will have a waiver of premium provision or a disability premium waiver rider that will set forth the required information and documentation for waiver of premium for disability.

What Is the Waiting Period for a Waiver of Premium Rider?

The waiver of premium waiting period varies among insurance companies, but commonly an employee who becomes disabled and is out of work must wait six months before applying for a waiver of premium.

What the insurance company and the employer does in those six months will dictate whether the insured continues coverage under the policy, or the policy lapses.

Was Your Claim Denied Due to Lapse?

If the insured was disabled and out of work before dying and had employer-provided term insurance with a waiver of premium rider, but a beneficiary’s death benefit claim was denied due to lapse, it might be because the policy lapsed and was terminated improperly. It is common for either the employer or the life insurance company to mishandle or improperly deny the employee’s request for disability waiver of premium payments.

Employer Responsibility For Group Life Insurance Under Erisa

Employers frequently provide group life insurance for their employees as part of their benefit package. Often the group policy also covers the employee’s qualified dependents.

In some cases, the employer will pay the premiums on behalf of employees. In others, the employer will pay the premium in part or not at all, and deduct that cost from the employees’ paychecks.

The amount of coverage the employee purchases is usually based upon a multiplier of the employee’s annual salary and will also depend upon whether the employee opts for any supplemental insurance, such as an ADD (accidental death and dismemberment) rider.

Employers Have a Fiduciary Responsibility to Act in the Best Interests of Employees With Regard to the Group Life Insurance Policy

The employer, or the employer’s human resource department, is responsible for explaining the benefits and responsibilities of the employee under the group life insurance plan.

Unfortunately, employers often fail to provide employees with the policy itself, or with any information about what is a qualified loss and who is a qualified dependent, or even with the application they need to complete and submit to continue coverage under the plan should they become disabled and unable to work.

In any of these cases, the employer is responsible for any lapse in coverage, and despite that lapse the beneficiary can be paid. For example, in a recent case, we got our client’s death benefit claim paid when the insured was out of work on short-term disability, and the insured’s employer failed to provide an application for waiver of premium or an application for conversion to an individual policy within the required 31-days.

In another recent case, we got our client’s death benefit claim paid when the insured could not work due to battling colon cancer, and again, his employer failed to provide an application for waiver of premium or notice of the right to convert to an individual policy.

Insurance Company Responsibility Under Erisa

The policy provision or rider pertaining to waiver of premium payments due to disability will define “totally disabled,” and every insurance company defines it differently. Usually, the definition takes some form of the following:

A person is “totally disabled” for the purpose of life insurance premium waiver if that person is unable to perform the duties of an occupation for which he or she is qualified by education, training, or experience, and that disability was caused by an injury or illness.

Often life insurance companies deny a premium waiver application and argue that the insured does not meet the definition of “totally disabled”. Then, if the premium is not waived and the insured fails to pay the premium, the policy lapses.

In these cases, we vigorously challenge that decision and argue that it should be reversed and the beneficiaries paid on their claims. We have been very successful in getting denial of disability premium waiver cases reversed and getting our clients paid.

Insurance Companies Make Mistakes, Too

We have also been successful in getting our beneficiary clients paid where coverage lapsed because the life insurance company:

made an administrative error,
mishandled the premium waiver application, or
did not properly apply premium payments to the insured’s account, for example, when the insured had flexible or vanishing life insurance premiums.

We Get Beneficiaries Paid

The experienced life insurance beneficiary attorneys at Boonswang Law can help you find out if the employer or the insurance company was at fault for coverage lapse when the insured should have been eligible for waiver of premium for disability. Call us at 1-855-240-9160 or complete the online contact form, and we will discuss your case with you, free of charge.