Getting Your Life Insurance Claim Benefits Paid Even if You Have Been Denied Based on No Evidence of Insurability “EOI”

We have been successful on getting life insurance claims paid when the employer’s insurance company says a document called an “EOI” for “Evidence of Insurability” has not been completed. If you or your loved one had a paycheck deduction, paying life insurance coverages, only to have the claim later denied based on the lack of some document called an “EOI”, or “Evidence of Insurability” we have long argued that these denials are unjust. These claims must be paid.

Even if your denial of your life insurance claim was up to four years ago, we can go back and reopen the claim. Even though this is a long window to look back, don’t let this time go by! The longer since the claim was denied, generally the more difficult it is to reopen the claim and get it paid. But we urge you, for the benefit of your family, to get us working on your past denied life insurance claim, especially if it was denied based on a lack of Evidence of Insurability EOI document, if denied in the last 4 years.

A life insurance claimant denied benefits because there was no Evidence of Insurability (EOI) can still pursue payment through various approaches, including understanding the specific reasons for the denial, leveraging legal or policy frameworks, and possibly filing appeals or legal claims based on insurance law. Evidence of Insurability is a part of the life insurance underwriting process that requires proof of a person’s health status before being insured. But many times, when an employee is signing up for benefits, especially on-line, there is no one from the employer or the insurance company who actually asks for this form to be completed. Nobody even sends the form to the employee, not in paper form or even by PDF. But the insurance premium is paid through the employee’s payroll deduction. Then, unfortunately, the person dies. Too many people are surprised at the later denial of a life insurance claim, even though they paid the premiums, when the life insurance company says there was no Evidence of Insurability (EOI). However, claimants who were denied benefits due to a lack of EOI may have recourse depending on the circumstances of the denial, applicable state and federal laws, and the terms of the insurance policy.

Understanding Evidence of Insurability (EOI) and Its Role in Life Insurance

Evidence of Insurability (EOI) is documentation or proof that a person seeking life insurance is insurable based on their health and risk profile. Insurance companies often require EOI to assess whether a person qualifies for coverage, particularly when they apply for additional insurance beyond the guaranteed amount or after an initial enrollment period.

EOI typically includes health questionnaires and may involve medical exams or reports from healthcare providers. If a person fails to submit the required EOI, or if the EOI shows that the person has health issues that pose a high risk, the insurance company may deny coverage.

For a claimant to receive benefits after a denial based on lack of EOI, it is essential to explore why the denial occurred and whether there is any legal or procedural way to challenge it.

Common Reasons for Denial of Benefits Due to Lack of EOI

There are several common reasons why life insurance claims are denied due to the absence of EOI:

Incomplete EOI Application: If the employee did not submit a complete or accurate EOI form, the insurer may deny coverage, asserting that the policy was never fully underwritten. Usually the denial is based on the lack of any Evidence of Insurability EOI form being submitted. Our clients are shocked to hear that both the employer and the life insurance company deny that they even have to ask people to complete the form. The employers and life insurance company typically point to some hidden language or fine print, claiming that the employee had the total responsibility to get the Evidence of Insurability EOI form, and not the people who actually manage the applications and plan.

Late or Missing Evidence of Insurability EOI Submission: In some cases, the policyholder might have missed the deadline to submit their Evidence of Insurability EOI, especially if they applied for additional coverage after the initial enrollment period. This is a second, and more tricky denial of the life insurance claim that we have seen. Even if the employee did submit the Evidence of Insurability EOI, the insurance company may try to deny the claim, saying that the form was not submitted during the right time. The right time may be a limited window of time for open enrollments, or enrollments after the employee qualified. But again, this ground of denial of the life insurance claim, that the Evidence of Insurability EOI form was submitted at the wrong time, is something that we can fight.

Challenging Denial Based on Lack of Evidence of Insurability EOI

A denied life insurance claimant who was told there was no EOI can pursue payment by challenging the denial through various methods, including policy review, legal avenues, and appeals processes. Each strategy may depend on the details of the policy and the circumstances leading up to the denial. We urge you to not do this complicated, administrative work on your own, but to have us do it.

Documents We Need to Get Your Life Insurance Claim Paid Even if You are Denied on Evidence of Insurability EOI– Get the Insurance Policy and Enrollment Materials

One of the first steps for a claimant is to carefully review the terms of the insurance policy and any enrollment materials the policyholder may have signed.

If You are Already Denied, and Need to Appeal, Please Consult Us

Most insurance companies, including those operating under group life insurance plans governed by ERISA (Employee Retirement Income Security Act), offer a formal appeals process for denied claims. Claimants can challenge the denial by submitting an appeal letter that addresses the reasons for denial and provides supporting documentation to demonstrate coverage.

Appealing Based on Administrative Errors: If the denial was due to administrative mistakes, such as the policyholder not being properly notified of the need for EOI or missing deadlines due to the insurance company’s communication failures, this can be a basis for an appeal. Providing documentation that proves the policyholder was eligible for coverage or that errors occurred during the EOI process can strengthen the appeal. However, we see that the life insurance companies and the employers deny that they even have to provide the Evidence of Insurability EOI materials for the employee to complete at the start.

In cases involving group life insurance policies provided through an employer, the plan is often governed by ERISA. Under ERISA, claimants have specific rights to challenge denied claims, and the appeals process is mandatory before resorting to litigation.

Filing an ERISA Appeal: For claimants whose policies fall under ERISA, it is essential to exhaust all administrative remedies, including the internal appeals process, before filing a lawsuit. ERISA also requires the insurance company to provide a clear and comprehensive explanation for why a claim was denied and to furnish the claimant with access to the documentation and reasoning behind the decision. If you are the claimant, you really should not do the appeal without a qualified lawyer. The insurance company has already denied the claim, despite your best efforts. To get a different result, you need something different–life insurance lawyer now as your lawyer.

Some different arguments that we may use on a life insurance appeal. Several court cases and legal precedents have shaped how claims involving lack of EOI are handled, particularly when claimants challenge denials. Miscommunication or Administrative Errors: Courts have sometimes ruled in favor of claimants when it can be shown that the insurance company or employer failed to provide clear instructions about the EOI requirement. In such cases, claimants may successfully argue that the lack of coverage was due to the insurer’s or employer’s failure to fulfill their responsibilities. Under ERISA, courts have consistently held that plan administrators and insurers must provide clear, comprehensive reasons for denying a claim and ensure that claimants are given access to the documentation and criteria used to make the decision. This transparency can help claimants build their case during the appeals process. Precedents in Denied Coverage Cases. In some cases, courts have ordered insurance companies to pay benefits when it is found that the insurer did not properly enforce the EOI requirement or acted in bad faith. For example, if the insurer accepted premiums but later denied coverage on the grounds of no EOI without having properly communicated that requirement, the court may rule in favor of the claimant.

While being denied life insurance benefits due to lack of Evidence of Insurability can be disheartening, claimants still have several avenues to pursue payment. By carefully reviewing the policy, understanding the specific reasons for denial, and exploring appeals and legal options, claimants can challenge wrongful denials and potentially recover the benefits they are owed.

We have done this a lot. We take the time to know you and your case. We start working for you NOW. We communicate with you, respond to your calls, are available to you. We focus on how to win your case. If you have a problem getting your life insurance claim paid, rescission, beneficiary disputes, or your policy has been cancelled or has other issues on it, you need to contact Life Insurance Lawyer NOW.com or life insurance justice.com. Use the form on our site, or email us, or call (888) 997-4070 or (818) 937-0937 to speak directly to an experienced life insurance lawyer. We are the best life insurance lawyers around, and we are real lawyers, not a lawyer referral service or “middleman”, and we are nice to work with, too; we are here for you NOW.