Those who are employed with a business or company may have life insurance through their employer. If the insured has life insurance through his or her work, then the benefits will usually be part of a group policy. In a group policy the employer is typically the policy holder.
The employee will be considered a participant in the group policy. The policy will normally provide that an insurance company will pay the death benefit pursuant to the terms of the group policy contract.
If an employee has life insurance benefits through the employer, those benefits will probably be governed by ERISA, which is a federal law. ERISA governs certain kinds of employee welfare benefit plans. These plans are administered by a plan administrator, who is usually associated with the insurance carrier or employer.
If the employee passes away, then the beneficiary must submit the claim to the plan administrator to obtain the benefits. The claim will then go through a claims process under which the plan administrator will evaluate whether the claim is covered by the group policy or plan.
If the plan administrator denies the claim, the beneficiary will be allowed to file an appeal. However, if the appeal is also denied then the beneficiary will have to seek legal redress through the courts.
Our firm handles ERISA-based life insurance claims. Since these claims are usually governed by federal law, we are equipped to litigate these claims in the federal courts. Our attorney, Joe Rosen, is a member of all of the federal courts in the state of Florida.