What to Do If Your Life Insurance Claim Is Denied: The Complete Plan to Appeal
People purchase life insurance as part of long-term financial planning—to protect their loved ones and ensure they are supported after the insured’s death. When a life insurance company denies a claim, families often feel blindsided and financially vulnerable. Unfortunately, life insurance claim denials are far more common than most people realize. Large insurers routinely deny claims for technical, procedural, or legal reasons, leaving beneficiaries confused about what to do next.
If your life insurance claim has been denied, you still have rights—and you may still be entitled to the full payout. In this comprehensive guide, our life insurance attorneys explain why life insurance claims get denied, what steps to take immediately, and how to successfully appeal a denied life insurance claim. For a free case evaluation, call (888) 510-2212.
What Happens When a Life Insurance Claim Is Denied?
When an insurance company denies a life insurance claim, it must send a written denial letter explaining:
The specific reasons for denial
The policy provisions the insurer relied upon
What documents were reviewed
Your right to appeal
The deadlines to file an appeal or lawsuit
This denial letter is crucial evidence. If you were denied verbally over the phone, you have the right to demand a written denial. Insurers sometimes refuse to even allow a beneficiary to file a claim, offering excuses such as:
“The policy lapsed—there’s no coverage.”
“The death wasn’t accidental, so the AD&D policy won’t pay.”
“You can’t file a claim because you’re an ex-spouse.”
“Coverage ended when the insured left employment.”
These statements are often incorrect. Insurance representatives frequently misunderstand the law, eligibility rules, and state-specific protections. If you are told any of these statements over the phone, speak with a life insurance lawyer immediately.
Common Reasons Why Life Insurance Claims Get Denied
Life insurance companies deny claims for dozens of reasons. Some are legitimate; many are not. Below are the most common reasons insurers cite:
Failure to reinstate coverage
Policy lapse due to missed payments
Misrepresentation on the application
Failure to disclose medical history
Contestability investigation issues
Age or income misstatements
Death related to alcohol or drug use
Excluded causes of death
Suicide exclusions
Self-inflicted injury
Death outside policy time limits
Death in a foreign country
Beneficiary disputes
Employer paperwork errors
Failure to convert or port group coverage
Termination of employment
Prescription drug misuse
Failure to provide evidence of insurability
Our attorneys break down these issues in detail in our guide to reasons life insurance will not pay out.
Why the Contestability Period Matters in Denied Life Insurance Claims
If a life insurance policy is less than two years old, it is subject to the contestability period. During this time, the insurer can investigate the insured’s medical history, application answers, and background. Even minor, irrelevant omissions can cause the insurer to deny a claim.
However, many contestability denials are wrongful. If the alleged misrepresentation did not contribute to the insured’s death, state law may require the insurer to pay. Beneficiaries can win contestability appeals if the denial is legally or medically flawed.
How to Fight a Denied Life Insurance Claim
When beneficiaries receive a denial letter, many become discouraged and assume they have no options. But denial is not the end of the road. Beneficiaries have the right to challenge, appeal, or litigate a denial. Even if the insurer upholds its denial on appeal, a life insurance attorney may still be able to recover the payout.
Below is the full step-by-step plan to appeal a denied life insurance claim.
Step 1: Contact the Life Insurance Company for Clarification
A denial letter must contain specific reasons for denial. If the letter is vague or unclear, contact the insurer and request:
A detailed explanation
All policy provisions relied upon
A copy of the claim file
Instructions for filing an appeal
Required documents (autopsy, medical records, receipts, etc.)
You must also confirm whether the policy includes an administrative appeal process and the deadline for filing.
If the denial references a legal statute or policy exclusion, a life insurance lawyer can determine whether the insurer applied the law correctly.
Step 2: Contact a Life Insurance Lawyer to Appeal the Denied Claim
This is the most important step.
Appealing a life insurance denial is a legal process—not just administrative paperwork. A life insurance lawyer will:
Investigate the denial
Collect evidence and documents
Conduct legal research
Identify insurer mistakes
Prepare a comprehensive appeal brief
Ensure deadlines are met
For ERISA-governed group policies, the appeal must be filed within 60 or 180 days depending on the plan. If you miss this deadline, your right to benefits may be permanently lost.
Why the Appeal Must Be Done Correctly
For ERISA claims, the appeal forms the administrative record, which is the only evidence a federal judge will review if the case goes to court. This means:
If evidence is not included in the appeal, you may never be allowed to use it later.
This is why beneficiaries should never file an appeal without legal guidance.
Step 3: File a Strong Administrative Appeal
Your appeal must be supported by:
Factual evidence
Medical records
Payment proof
Legal arguments
Expert reports (if needed)
Policy interpretation analysis
A strong appeal can overturn the denial before litigation becomes necessary.
Step 4: File a Lawsuit if the Appeal Is Denied
If the appeal fails, you may file a lawsuit. The process depends on whether the claim is governed by state law or ERISA. ERISA lawsuits:
Are typically filed in federal court
Do not involve jury trials
Are decided by a judge
Are limited to the administrative record
An experienced life insurance lawyer will navigate these rules and build the strongest possible case.
How Our Life Insurance Lawyers Can Help
Our attorneys handle denied life insurance claims involving:
Policy lapse
Misrepresentation
Contestability reviews
Beneficiary disputes
Employer paperwork errors
Excluded causes of death
Accidental death denials
ERISA claim denials
We work on contingency, meaning you pay nothing unless we recover the payout.
Examples of our results include:
$100,000 recovered after appealing a lapse denial
$1,000,000 collected after a contestability-period lapse denial
$550,000 recovered after a misrepresentation denial
$1,000,000 awarded in a beneficiary dispute involving a murder-suicide
If your life insurance claim has been denied, call (888) 510-2212 for a free consultation.
