Our client called us after MetLife denied her ERISA life insurance claim. At the time of his death, our client’s husband had company – provided optional group life insurance coverage. He was eligible to apply by this coverage by virtue of his employment. To obtain this coverage, the insured was required to provide his medical history and complete a Statement of Health. MetLife approved his SOH and issued coverage for $150,000. Several days after his approval for the $150,000, the insured applied for an additional $70,000 in optional life insurance coverage. He was approved for this increase. MetLife never requested another SOH to be completed by the insured again.
MetLife increased the premium payments and accepted the increased payment until the insured’s sudden death from a cardiac arrest. When our client filed a claim for benefits, MetLife sent her a denial letter stating that her late husband never submitted a second SOH to MetLife and, therefore, the coverage for additional $70,000 never took effect. MetLife stated that as per Policy terms, Michael was required to complete another SOH in order to qualify for the additional life insurance coverage. Neither the insured nor Employer has ever received a request for a second SOH from MetLife. Our firm filed an ERISA appeal immediately after the investigation was complete. MetLife reversed the denial of benefits on appeal and sent our client the full amount of her life insurance proceeds within 45 days from the appeal date.