Understanding the ERISA Appeal Process: What Beneficiaries Need to Know to Win a Denied Life Insurance Claim
When a loved one passes away, family members expect that a group life insurance policy—often provided through an employer—will deliver the financial protection the insured intended. But for many beneficiaries, the shock of losing a family member is followed by a second blow: a denied life insurance claim under an ERISA-governed plan.
ERISA, the Employee Retirement Income Security Act of 1974, governs most employer-sponsored group life insurance plans in the United States. Although ERISA was designed to protect employees and their beneficiaries, the process is notoriously complex, technical, and stacked with strict deadlines. Many beneficiaries lose their right to benefits simply because they did not understand the ERISA appeal process—or waited too long to act.
In this comprehensive guide, our ERISA life insurance attorneys explain:
What ERISA is and why it applies to your claim
How the ERISA appeal process works
Critical deadlines every beneficiary must follow
What evidence you must include to win your appeal
What happens if your ERISA appeal is denied
How an ERISA attorney can significantly increase your chances of success
If your ERISA life insurance claim has been denied, call (888) 510-2212 for a free consultation.
What Is an ERISA Life Insurance Claim?
Most employer-provided group life insurance policies are governed by ERISA. These are typically:
Employer-sponsored benefit plans
Group life insurance policies purchased through the workplace
Plans where premiums are deducted from paychecks
Policies in which the employer contributes to or fully pays premiums
ERISA does not apply to group plans provided by:
Government agencies
Public schools
Religious institutions
Church organizations
Even though ERISA provides certain rights and protections, many beneficiaries are still denied benefits due to:
Alleged misrepresentation
Enrollment mistakes
Employer negligence
Policy lapses
Portability issues
Missing forms
Administrative errors
Failure to submit evidence during the appeal
Understanding the ERISA Appeal Process
If your claim is denied, you cannot immediately sue the insurance company. Under ERISA, you must first go through the administrative appeal—a mandatory step before filing a lawsuit.
Skipping the appeal can completely bar your legal claim, leaving you with no recourse.
This process is complicated, and insurers know that most individuals will not understand how to navigate it correctly. That is why working with an experienced ERISA attorney early is crucial.
How to File an ERISA Appeal Successfully
When a claim is denied, the insurer must send a written denial letter that outlines:
The reason for the denial
The appeal deadline
Where and how to submit your appeal
The name of the claims reviewer
The evidence used to deny the claim
You Only Get ONE ERISA Appeal
This is perhaps the most important rule:
❗ ERISA allows only one administrative appeal.
If you lose it or file a weak appeal, you cannot submit another one.
Once the appeal is decided, the administrative record closes—and you cannot add new evidence later, even in court.
Your appeal must include everything:
Every legal argument
Every document
Every piece of evidence
Every expert report
Anything left out cannot be added later.
Critical ERISA Appeal Deadlines
ERISA appeal deadlines are strict and unforgiving.
Most denial letters provide:
60 days to file an appeal, or
180 days for certain plans
Missing the deadline means you waive your right to pursue the claim further—no lawsuit, no second review, no benefits.
Many beneficiaries lose claims simply because they do not act quickly enough.
Avoid This Common Mistake
Calling the insurance company to ask questions can unintentionally trigger an appeal. If you say, “I want to appeal,” some insurers will treat the phone call as your one and only appeal—closing your ability to submit evidence later.
Instead, say:
“I am preparing an appeal. Please send me the complete claim file and policy.”
Do NOT let the insurer start the appeal until your evidence is ready.
What to Include in a Strong ERISA Appeal
A winning ERISA appeal must be thorough, evidence-based, and legally strategic. It should include:
✔ All new evidence
Medical records
Legal briefs
Expert opinions
Autopsy reports
Lab results
Research evidence
Workplace records
Enrollment documents
✔ The entire claim file
Federal law allows you to request the insurer’s entire file, including:
Notes
Calls logs
Internal emails
Recorded calls
Underwriting documents
The full policy
Claim forms
Employer communications
✔ Relevant ERISA provisions
Your appeal should cite the specific portions of ERISA and the policy that support your right to benefits.
✔ Statements from witnesses
Affidavits from family members, coworkers, supervisors, physicians, or anyone with relevant knowledge can strengthen your appeal.
Why Most Self-Filed ERISA Appeals Lose
Even smart, organized beneficiaries struggle to win ERISA appeals because:
ERISA law is highly technical
Insurers rely on loopholes and procedural arguments
Missing one document can destroy the appeal
Many beneficiaries do not know what evidence they’re entitled to
Most people don’t realize every argument must be made before the record closes
Courts review ERISA cases based only on the administrative record—not new evidence. If your appeal fails, litigation becomes much harder.
This is why attorney-drafted appeals win far more often than self-written ones.
What Happens If Your ERISA Appeal Is Denied?
If your administrative appeal is denied, you cannot submit another one. But you may now move to the next step:
Filing an ERISA Lawsuit
Only after the insurer issues a final denial can you sue. ERISA lawsuits are handled in federal court and can challenge:
Wrongful interpretations of the policy
Improper reliance on employer errors
Failure to consider evidence
Incomplete review of the claim
Procedural violations
Misapplication of eligibility rules
Bias by plan administrators
Our law firm handles ERISA litigation nationwide and has overturned many wrongful denials—including those based on:
Material misrepresentation
Employer enrollment mistakes
Missing health statements
Domestic partnership documentation
Failure to process portability applications
Why You Should Work With an ERISA Life Insurance Lawyer
ERISA cases are vastly different from standard life insurance claims. They require:
Knowledge of federal ERISA regulations
Experience handling administrative appeals
Understanding of strict deadlines
Skill drafting comprehensive legal briefs
Ability to analyze complex employer-provided plan documents
A strong ERISA attorney can:
Obtain the insurer’s claim file
Uncover mistakes by employers or insurance companies
Gather and submit strong evidence
Prevent procedural errors
Draft winning appeal briefs
File a federal lawsuit if needed
Our firm works on a contingency fee basis, meaning you do not pay unless we recover benefits for you.
Our ERISA Attorneys Have a Proven Track Record
At Kadetskaya Law Firm LLC, we have helped beneficiaries win ERISA claims involving:
Denied ERISA claim due to alleged misrepresentation
Denied claim caused by employer and insurer negligence
Denied benefits due to missing domestic partnership documentation
Denied ERISA claim for missing health statement
Portability disputes
Coverage lapses caused by employer error
Failure to inform employees of conversion rights
We understand how devastating a claim denial can be—especially after losing a loved one. Our attorneys fight aggressively for the benefits you are owed.
Get a Free ERISA Consultation Today
If your ERISA life insurance claim was denied, do not wait. The clock is already ticking, and missing deadlines can permanently destroy your case.
Call (888) 510-2212 for a free consultation with an experienced ERISA life insurance lawyer. We will help you understand your rights, build a strong appeal, and fight to recover the benefits your loved one intended for you.
