If a life insurance claim is denied under an ERISA plan, the claimant must follow the procedural requirements for an appeal according to ERISA law. The standard of review for ERISA claims is either de novo or abuse of discretion, depending on whether the plan grants discretionary authority to the insurer or administrator. The standard of review can greatly affect the outcome of any litigation for insurance benefits, as it determines how much deference the court gives to the insurer’s decision.
An ERISA appeal of a denied life insurance claim is a written request to the insurer or plan administrator to reconsider their decision and provide the benefits that are owed to the beneficiary. The appeal must follow the procedural requirements and deadlines specified by ERISA law and the plan document. The appeal should include:
A copy of the denial letter and any other relevant correspondence from the insurer or plan administrator
A statement of why the denial was wrong and why the claim should be approved
Any evidence or documentation that supports the claim, such as medical records, death certificate, policy certificate, beneficiary designation form, etc.
Any legal arguments or authorities that support the claim, such as ERISA regulations, case law, etc.
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