ERISA and Denied Employee Benefits Claims
While the goal of ERISA is to protect the legal rights of employees and their beneficiaries, many of them still have difficulties recovering the benefits they are entitled to. ERISA is a complex law and it is best to consult with an experienced employee benefits attorney who can file an appeal if your claim was denied. Was your group life insurance claim denied due to Evidence of Insurability? Learn more →
When a life insurance lawyer prepares an ERISA appeal, they draft a legal brief based on ERISA law and the results of an independent investigation and research. This forces the insurance company to examine the case from a new perspective. Beneficiaries who win ERISA appeals at an administrative level save time and money that would otherwise be spent on litigation. At our ERISA law firm, we urge everyone whose benefit claim was denied to hire an ERISA counsel before filing an appeal to increase their chances of winning.
Denied claim? Not sure where to start? Read our step-by-step guide on what to do after a denial →
Speak With a Life Insurance Attorney
If your life insurance claim has been denied, delayed, or placed into interpleader:
1-888-510-2212
Our Experience in Handling Denied ERISA Claims
At Kadetskaya Law Firm LLC, we have a high success rate of recovering insurance proceeds on ERISA appeals and will make sure your ERISA appeal is handled professionally and competently. Our ERISA lawyers have considerable experience in winning cases involving claim denials including:
Denial based on failure to provide a conversion application
Denial based on change in marital status
Denial based on policy exclusions
Denial based on employer non-payment of premium
Denial based on failure to apply for waiver of premium
Denial based on failure to provide an evidence of insurability form
Denial based on employer’s mistake
Denial based on not being actively at work
Denial based on dependent ineligibility
Here are just a few cases successfully handled by our ERISA lawyers:
Denied ERISA claim due to material misrepresentation on Portability Application. ERISA misrepresentation and contestability denials follow different rules. Learn more →
Denied ERISA claim based on employer and insurer negligence
Denied ERISA claim for ex-spouse
Denied claim due to material misrepresentation during the contestability period – We recovered $150,000 on the appeal
Denied claim due to beneficiary dispute – We recovered $1.1 million from Minnesota Life Insurance Company
In most ERISA cases, an administrative appeal is a necessary step before the claim proceeds to court. If you decide to sue your insurance company without first exhausting administrative remedies, your court action may be barred. Therefore, you need to consult an experienced ERISA attorney who will file an appeal on your behalf. Our life insurance lawyers can help you recover your wrongfully denied claim fast, regardless of the reason invoked by the insurer. Note: FEGLI is governed by FEGLIA, not ERISA. Learn more about FEGLI claims →
ERISA Attorney Fees
Our attorneys work on a contingent fee basis. It means that we do not charge legal fees unless we collect the ERISA proceeds for you. Only then will we charge a reasonable legal fee. We take pride in offering competitive contingent fee structures and will work with you to ensure you are comfortable with the fee. If your ERISA claim has been denied or delayed, seek legal advice from an ERISA attorney. Call (888) 510-2212for a free case evaluation. We have the experience you can trust.
Speak With a Life Insurance Attorney
If your life insurance claim has been denied, delayed, or placed into interpleader:
1-888-510-2212
Free Consultation.
Contact Kadetskaya Law Firm LLC
If your life insurance claim has been delayed for weeks or months with no payment and no clear explanation, do not wait for the denial letter. The time to act is now.
(888) 510-2212
Free Consultation
No fees unless we win.
Kadetskaya Law Firm, LLC
630 Freedom Business Center Dr
3rd FloorKing of Prussia, PA 19406
(888) 510-2212
info@life-insurance-lawyer.com
ERISA Life Insurance Claims · Nationwide Representation
What Is ERISA and Why Does It Matter for Your Life Insurance Claim?
ERISA — the Employee Retirement Income Security Act of 1974 — is a federal law that governs most employee benefit plans offered by private employers. If your loved one had life insurance through their job, that policy is almost certainly governed by ERISA rather than state insurance law. That distinction changes everything about how your claim is handled, what rights you have, and what happens if the claim is denied.
ERISA preempts state law. This means the state consumer protection laws and insurance regulations that apply to individually purchased life insurance policies generally do not protect you when the policy comes from an employer. ERISA's rules are stricter, its deadlines are shorter, and its remedies are more limited — which is exactly why insurance companies prefer ERISA-governed plans and why beneficiaries need specialized legal representation when dealing with them.
Critical Deadline Warning
ERISA requires you to appeal a denied claim within 180 days of receiving the denial letter. Missing this deadline can permanently bar your right to sue — even if the denial was completely wrong. If your employer-provided life insurance claim has been denied, contact an attorney immediately.
How ERISA Claims Differ From State Law Life Insurance Claims
Most beneficiaries do not realize they are dealing with an ERISA claim until the insurer cites federal law in a denial letter. By then, critical deadlines may already be running. Understanding how ERISA differs from state law is essential to protecting your rights.
ERISA-Governed Employer Plans
- 180-day appeal deadline — strictly enforced
- Must exhaust administrative appeals before suing
- Federal court only — no jury trial
- Judge reviews the record as it existed at appeal
- New evidence generally not allowed in court
- Remedies limited to the benefit amount owed
- State bad faith laws do not apply
- Divorce decree may not override beneficiary form
Individual State-Governed Policies
- Longer appeal and lawsuit deadlines
- Can often sue without prior appeal
- State or federal court — jury trial available
- New evidence can be introduced in court
- Full discovery and witness testimony
- Bad faith damages available in many states
- State consumer protection laws apply
- Automatic revocation statutes may apply at divorce
Because ERISA cases are decided almost entirely on the administrative record — the documents submitted during the appeal — it is critical to build that record correctly from the start. What you submit during the appeal is what the court reviews. There is rarely a second chance to introduce new evidence once the case reaches federal court.
Common Reasons ERISA Life Insurance Claims Are Denied
ERISA life insurance denials follow predictable patterns. Insurance companies use the same arguments repeatedly — and they count on beneficiaries not knowing how to challenge them. These are the most common denial bases we see and successfully challenge:
Evidence of Insurability not submitted
Insurers deny claims arguing the insured never completed an EOI form for supplemental coverage. But employer and insurer errors in the enrollment process are frequently recoverable. Learn more →
Not actively at work
Policies often require the insured to be "actively at work" on the effective date of coverage. Insurers use this to deny claims when the insured was on leave, ill, or working reduced hours.
Employer failed to enroll or remit premiums
When an employer fails to properly enroll an employee or stops remitting premiums without notice, the insurer may deny the claim — but the employer may be liable and the insurer may be estopped from denying coverage.
Portability application not completed
When an employee leaves a job and fails to convert group coverage to an individual policy, the insurer denies the claim. These denials are often challengeable where the employer failed to provide proper notice. Learn more →
Beneficiary dispute or competing claim
When multiple parties claim the same benefit — such as an ex-spouse and a current spouse — the insurer may file an interpleader or freeze the claim. Learn more →
Material misrepresentation during contestability
Within the contestability period, insurers investigate applications for alleged misrepresentation. ERISA misrepresentation claims follow different standards than state law and can often be challenged on appeal.
Dependent ineligibility
Insurers deny dependent life insurance claims arguing the dependent did not qualify under the plan definition — often when enrollment forms were never provided or the employer failed to update records.
Waiver of premium not applied
When the insured became disabled, the policy may have contained a waiver of premium provision — meaning premiums were not required. Insurers sometimes deny claims arguing the policy lapsed when the insured stopped paying, even when the waiver applied.
The ERISA Appeal Process: What Happens After a Denial
An ERISA appeal is not a simple letter asking the insurance company to reconsider. It is a legal brief — a formal written submission that builds the evidentiary and legal record on which your case will be decided, both at the administrative level and in federal court if litigation becomes necessary. The quality of the appeal determines the outcome of the case.
- Obtain the complete claims file. Under ERISA, you are entitled to the full administrative record — every document the insurer relied on in denying your claim. We demand this file immediately so we know exactly what the insurer reviewed and what arguments they made internally.
- Analyze the plan documents. The policy, the summary plan description, and any amendments are reviewed against the denial to identify every legal and factual error the insurer made. Insurance companies frequently misapply their own plan language.
- Build the evidentiary record. Because courts review only what was in the administrative record, we submit all relevant evidence during the appeal — medical records, expert opinions, employment records, enrollment documents, and any other evidence supporting the claim. Nothing can be added later.
- Draft the legal appeal brief. We prepare a formal brief citing ERISA law, relevant case precedents, and the specific failures in the insurer's denial. This is not a template letter — it is a legal document tailored to your specific policy, plan, and denial.
- Submit within the 180-day deadline. The appeal must be filed within 180 days of the denial letter. Missing this deadline forfeits your right to sue in most cases.
- Await the insurer's decision. Under ERISA, the insurer generally has 60 days to respond to an appeal (90 days in special circumstances). If the appeal is denied, we proceed to federal court.
- Federal court litigation if needed. If the administrative appeal is unsuccessful, we file suit in federal district court. ERISA cases are decided by judges, not juries, based primarily on the administrative record — which is why building that record correctly during the appeal is so critical.
"I was told by other attorneys not to expect the insurance company to award the claim. Tatiana cited case law and expert witness assessment in the appeal — the insurance company immediately awarded the full policy amount."
— Client, ERISA denial caseERISA claim denied? The 180-day clock is running.
Free case review · No fees unless we win · Nationwide representation
ERISA Life Insurance and Divorce: A Critical Warning
One of the most painful consequences of ERISA preemption involves divorce. When a privately purchased life insurance policy is governed by state law, many states automatically revoke an ex-spouse's beneficiary designation upon divorce. ERISA plans are different — federal law controls, and those state automatic revocation statutes do not apply.
The United States Supreme Court has confirmed this principle repeatedly. In ERISA-governed employer plans, the person named on the beneficiary designation form receives the death benefit — regardless of what the divorce decree says, regardless of whether the insured remarried, and regardless of any court order purporting to redirect those benefits to someone else. Families discover this rule at the worst possible moment.
If you are going through a divorce and have employer-provided life insurance — or if you are a beneficiary whose claim was denied because of a divorce-related beneficiary dispute — contact us immediately. The rules are complex and the stakes are high.
- State divorce automatic revocation statutes do not apply to ERISA plans
- A divorce decree cannot override a beneficiary designation form on an ERISA plan unless specific federal requirements are met
- A Qualified Domestic Relations Order (QDRO) applies to retirement plans — not life insurance — and cannot be used to redirect life insurance benefits
- Updating the beneficiary form with the plan administrator is the only reliable way to change the beneficiary on an ERISA life insurance plan
- If an ex-spouse collected ERISA life insurance benefits, the rightful beneficiary may have claims against the estate or other parties
See our full guide: Life Insurance and Divorce — Protecting Your Rights
Frequently Asked Questions: ERISA Life Insurance Claims
How do I know if my life insurance claim is governed by ERISA?
If the life insurance was provided through a private employer as part of an employee benefits package, it is almost certainly governed by ERISA. Government employer plans (federal, state, and local) and church plans are generally exempt from ERISA. If you are unsure, look at the denial letter — ERISA-governed plans are required to identify themselves as such and to inform beneficiaries of their ERISA appeal rights.
What is the deadline to appeal an ERISA life insurance denial?
ERISA requires plans to give beneficiaries at least 180 days to appeal a denied claim. Some plans provide longer periods — but never shorter. The 180-day period begins when you receive the denial letter. Missing this deadline generally bars you from suing the insurer in federal court, even if the denial was wrongful. Contact an attorney as soon as you receive a denial.
Can I sue an employer if ERISA life insurance was not offered or administered correctly?
Yes. Employers who sponsor ERISA plans have fiduciary duties to plan participants and beneficiaries. If an employer failed to enroll an eligible employee, failed to remit premiums, failed to provide required notices, or otherwise misadministered the plan, the employer may be liable for the lost benefits — even if the insurance company itself is not. These claims are separate from the claim against the insurer.
What happens if I miss the ERISA appeal deadline?
Missing the ERISA appeal deadline is serious — courts have consistently held that failure to exhaust administrative remedies bars subsequent litigation. However, there are limited exceptions: if the plan failed to provide adequate notice of the deadline, if the insurer's conduct prevented timely appeal, or if equitable tolling applies in the specific circumstances. An attorney can evaluate whether any exception applies in your case.
Can I get extra damages if the insurer wrongfully denied my ERISA claim in bad faith?
ERISA's remedies are more limited than state law. Unlike individual policies in many states, ERISA generally does not allow punitive damages or bad faith damages. Recovery is typically limited to the benefit owed plus interest and, in some cases, attorney's fees. This is one of the most significant disadvantages of ERISA-governed plans for beneficiaries — and one more reason why early legal involvement is critical to maximizing recovery.
What is the difference between ERISA and FEGLI?
FEGLI — the Federal Employees Group Life Insurance program — covers federal government employees and is governed by a separate federal statute called FEGLIA, not ERISA. FEGLI claims follow different rules, different appeal procedures, and different beneficiary designation requirements than ERISA-governed employer plans. Learn more about FEGLI claims →
Does ERISA apply to SGLI or VGLI military life insurance?
No. SGLI (Servicemembers' Group Life Insurance) and VGLI (Veterans' Group Life Insurance) are federal programs governed by a separate statute — the Servicemembers' Group Life Insurance Act — not ERISA. The rules for beneficiary designations, appeals, and court jurisdiction are different from ERISA. Learn more about SGLI claims →
Related Practice Areas
The information on this page is for general informational purposes only and does not constitute legal advice. No attorney-client relationship is created by reading this content. ERISA deadlines are strict — contact our firm directly for advice specific to your situation. Kadetskaya Law Firm LLC represents clients nationwide. © 2026 Kadetskaya Law Firm LLC. All rights reserved.