Life Insurance Claim Denied? Here's What To Do First.
The letter arrives a few weeks after the death of someone you loved, and it says the insurance company will not pay. Most people read a denial letter as a verdict. It isn't. It is the insurer's opening position, written by the insurer, for the insurer's benefit — and a large share of denials do not survive a proper challenge.
We have recovered millions of dollars for beneficiaries after denial letters, including $1 million from John Hancock after a wrongful lapse and full recoveries from MetLife, Prudential, Unum, and Guardian. What follows is the sequence we tell every family in the first two weeks.
Step 1 — Read the denial letter for two things
Every denial letter contains the two facts that shape everything after it: the stated reason for denial, and the deadline to appeal. Find both and write them down. If the policy came through an employer, the deadline is usually 60 to 180 days under ERISA — and missing it can end the claim permanently, no matter how strong it was.
Step 2 — Do not argue with the insurer yet
The most damaging mistakes happen in the first phone calls. Grieving people, trying to be helpful, volunteer information the insurer later uses: about the insured's health, habits, finances, or state of mind. You are not required to explain anything on the insurer's schedule. Be polite, confirm receipt, and say your family is reviewing the decision. Nothing more.
Step 3 — Request the complete claim file and policy
Send a short written request for: the full policy (not the summary), the complete claim file, everything the insurer relied on to deny, and — for lapse denials — every notice it claims it sent, with proof of mailing. Insurers must justify denials from their own records, and those records are frequently thinner than the confident denial letter suggests.
Step 4 — Preserve everything
The policy, premium bills, bank statements showing payments, enrollment paperwork from the employer, emails, and any notices that arrived. If the insured was ill, write out a timeline of hospitalizations and treatment. Documents win these cases; memories fade.
Step 5 — Understand what kind of denial you have
Denials cluster into a handful of types, and each has its own counterattack:
Lapse — the policy allegedly ended for non-payment. Often defeated by the insurer's own notice failures. How lapse denials fail →
Misrepresentation — the insured allegedly misstated something on the application. The insurer generally must prove the misstatement was material. More →
Exclusions — intoxication, drugs, sickness, suicide clauses. Construed narrowly against the insurer. Accidental death denials →
Eligibility / employer coverage — the insured allegedly wasn't covered at death. Frequently the employer's paperwork failure, which can create employer liability. ERISA claims →
Beneficiary disputes — the insurer received competing claims. This may become an interpleader lawsuit you must respond to. Beneficiary disputes →
Step 6 — Do not appeal on your own
This is the step that surprises people. Under ERISA, the administrative appeal is usually your one chance to put evidence into the record — and in later litigation, courts generally review only that record. An appeal that just says "I disagree" wastes the claim's only appeal right. Build the record like the lawsuit depends on it, because it does.
Step 7 — Get the denial reviewed by an attorney who does this work
Not because every denial needs a lawyer — some don't — but because the review costs nothing and the deadlines are unforgiving. A life insurance attorney can usually tell quickly whether a denial has the marks of a wrongful one: missing notices, unprovable materiality, an exclusion stretched past its language, or an employer's enrollment failure.
Contact Kadetskaya Law Firm, LLC
Our firm reviews denials for free and works on contingency — no fees unless we recover your benefits. We have recovered millions from major insurance companies.
If your life insurance claim has been denied or 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 Floor
King of Prussia, PA 19406
(888) 510-2212
info@life-insurance-lawyer.com
No fees unless we win.
***This page is for general informational purposes only and does not constitute legal advice. Contact our firm directly for advice specific to your situation.
