Life insurance claims likely fall under ERISA law (Employee Retirement Income Security Act) if the coverage is obtained through your employer. ERISA law covers most employee benefits and can be very tricky to navigate. ERISA law is a federal law which requires a claimant to follow the administrative procedures outlined in the policy or plan and file a federal lawsuit if coverage under the policy is denied. Many people contact our law firm because the process is not always clear and can be a huge undertaking to review the policy language and medical records associated with coverage.
Most people believe life insurance is an easy benefit to collect for obvious reasons; however, sometimes coverage depends on interpretation of one or more clauses in the policy. These clauses may involve the manner of death or the timing of death, or the coverage selected.
We were able to achieve a successful result for a client where the ERISA life insurance coverage was initially denied but our appeal showed the life insurance carrier denial did not consider that the decedent actually purchased supplemental coverage (instead of base coverage). The supplemental ERISA life insurance coverage offered different terms of coverage, including a different elimination period. Fortunately, under the supplemental ERISA life insurance coverage, the effective date of the coverage was different and our client, a 40-year old widow with two kids was able to obtain all the coverage her husband purchased which has changed her dire circumstances.