Delayed/Denied FEGLI Claims
Established in 1954 by the Federal Goverment, the Federal Employees Group Life Insurance (“FEGLI”) is a life insurance program that provides group life insurance to federal employees. FEGLI has 4,000,000 members and is the largest group life insurance program in the world. Federal employee are automatically enrolled in the basic program, with the option to waive enrollment or obtain additional coverage for themselves or family.
Common FEGLI Exclusions and Reasons For Claims Denial
- Bacterial Infection
- Drugs administered by you
- Foodborne illness
- Illegal drugs
- Nuclear War
- Nuclear Weapon
- Physical / Mental Illness
- Ptomaine poisoning
- Self-Inflicted Injury
- War (killed in action)
Frequently Asked Questions
Who handles FEGLI claims?
The Office of Personnel Management (“OPB”) facilitates FEGLI claims. FEGLI payments are paid directly to beneficiaries by Metropolitan Life Insurance Company (“MetLife”).
Does a FEGLI policy require a named beneficiary?
All FEGLI insureds must name a beneficiary and are extremely strict. For example, a named FEGLI beneficiary is the only valid recipient of FEGLI policy proceeds. FEGLI’s mandate regulates FEGLI policies, and therefore, state law is secondary to FEGLI claims. Recently, the Supreme Court heard a FEGLI case based on a FEGLI beneficiary dispute. The Supreme Court’s opined based on FEGLI claim precedent. During that case, the FEGLI insured died and the insured’s first wife was listed on the FEGLI policy. The insured failed to change his FEGLI beneficiary designation to his second wife. As a result, the Supreme Court ruled that the first wife was entitled to the policy proceeds. The second wife’s divorce argument failed due because federal rules regulate FEGLI beneficiary changes. Therefore, the federal FEGLI standard outweighs state life insurance laws.
What happens during a FEGLI beneficiary dispute?
A FEGLI insured may change beneficiaries if the insured complies with FEGLI’s beneficiary change form. The insured must sign the beneficiary change form in the presence of 2 witnesses. Prior to the insured’s death, OPM must approve of the beneficiary change. An issue may arise when OPM receives an insured’s beneficiary change form prior to the insured’s death, yet failed to approve of the beneficiary change before the insured dies. Additional issues arise where the beneficiary dispute form is submitted after the insured dies.
What is interpleader?
Interpleader arises in a life insurance dispute when an insurer cannot determine the beneficiary of a claim. Interpleader may come in many forms, however, the most common interpleader actions arise during disputes between beneficiaries. Beneficiary disputes can lead to an insurer filing an interpleader action. If the insurer files an interpleader lawsuit, the insurer places the policy proceeds in trust with the court. As a result, the court becomes the fact finder and determines the party entitled to the claim.
What happened is a FEGLI policy does not name a beneficiary?
If a FEGLi policy fails to name a beneficiary, the law looks toward several individuals. First, the insured’s FEGLI policy proceeds go to the insured’s widow. Second, the FEGLI policy proceeds go to the insured’s children. Third, the FEGLI policy proceeds go to the insured’s parents. Fourth, the FEGLI policy proceeds go to the insured’s estate. Lastly, the insured’s FEGLI policy proceeds go to his/her next of kin.
What happens if a FEGLI policy lapses?
When an insured fails to pay his/her FEGLI premiums, the insured’s life insurance coverage may lapse. If the insured fails to pay FEGLI premiums, FEGLI insurance benefits may terminate. During a non-payment of premiums period, the insured has 31-days repay back dated premium payments before the insured’s FEGLI insurer terminates the insured’s policy.
How does an insured reinstate a FEGLI policy?
If the insured intends to reinstate his/her FEGLI policy, the insured must complete a new beneficiary form. The insured may need to pay premiums and interest on unpaid premiums to reinstate the insured’s life FEGLI policy. A denied FEGLI claim can occur when an insured fails to address unpaid premiums.
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