Making and Contesting a Life Insurance Claim: A Practical Checklist

Insurance > Life Insurance Claims | Published 26 November 2024 - Updated 22 July 2025 | UpLaw - uplaw.us

Phase 2 comes before everything. Whether the coverage is an individual policy or employer group coverage determines the governing law, the remedy, the forum, and the deadline — and getting it wrong wastes the case.

The narrative is The Beneficiary Form Beats the Will: How Life Insurance Money Actually Moves. The doctrine is Life Insurance Claims and Beneficiary Disputes: A Comprehensive Guide to Contestability, Denials, and Competing Claims. The letters and templates are in The Life Insurance Claim and Beneficiary Dispute Toolkit.

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Phase 1 — Before contacting the insurer

☐ Order five to ten certified death certificates. Every institution keeps one. Reordering costs weeks.

☐ Locate the policy. If it cannot be found:

• ☐ Bank statements and tax returns for premium payments
• ☐ Employer benefits records, including any converted or ported coverage
• ☐ Unions, professional associations, credit cards, mortgage lenders
• ☐ Industry policy locator services
• ☐ State unclaimed property databases
• ☐ The decedent's agent, accountant, and estate planner

☐ Request the beneficiary designation in writing — the form actually on file, not what the family believes.

☐ Gather: the policy or certificate · the application, if available · premium payment history · any change-of-beneficiary forms or attempts · the divorce decree, if any · the will and trust · guardianship or custodianship documents for a minor.

☐ Note the policy issue date and any reinstatement date. This computes the contestability period.

☐ ⛔ Do not assume the will controls. It does not.

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Phase 2 — Individual or group?

☐ Ask: was this coverage provided through an employer?

	Individual policy	Employer group coverage
Law	State insurance law	Federal plan law — 29 U.S.C. § 1002
State claims	Available	Preempted — 29 U.S.C. § 1144; Aetna Health Inc. v. Davila, 542 U.S. 200 (2004)
Remedy	Contract, bad faith, consequential and punitive damages	The benefit, interest, and possibly fees — 29 U.S.C. § 1132
Jury	Usually	Usually not
Appeal	Optional	Mandatory; exhaustion required — 29 U.S.C. § 1133, 29 CFR Part 2560
Evidence	Discovery	The closed administrative record
Review	De novo	Abuse of discretion where the plan grants discretion — Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101 (1989)

☐ If group, request immediately — 29 U.S.C. § 1024:

• ☐ The plan document
• ☐ The summary plan description
• ☐ The complete claim file
• ☐ Any provision addressing revocation of a designation on divorce

☐ If government or military, go to Phase 8 — the statutory precedence order controls.

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Phase 3 — Filing the claim

☐ A separate claim form from each beneficiary.

☐ Submit with the first mailing: the certified death certificate · proof of identity · policy or certificate number.

☐ For a minor beneficiary: guardianship, custodianship, or trust documentation. Insurers will not pay a minor directly.

☐ For an estate beneficiary: letters of appointment — see Opening and Administering a Probate Estate: A Practical Checklist.

☐ For a trust beneficiary: a certification of trust.

☐ Disclose any known competing claimant. Concealing one delays everything and can cost the insurer's fees out of the fund later.

☐ Ask, in the cover letter:

• ☐ The date of policy issue and any reinstatement
• ☐ Whether the claim is within the contestability period
• ☐ The face amount and any outstanding policy loan
• ☐ Whether interest will be paid from the date of death
• ☐ Whether payment will be by check or retained asset account

☐ Expected timing: uncontested individual claims 30–60 days · contestable claims 4–8 months · contested or interpleaded, years.

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Phase 4 — If the death was within two years

☐ Expect a full investigation. The insurer will order medical records for the pre-application period, check prescription databases and the industry information exchange, and compare everything to the application.

☐ ⚠ Provide the medical authorizations. Refusing them is itself a ground for denial.

☐ Simultaneously, build the defense — before responding substantively:

• ☐ Obtain the original application, in the applicant's handwriting if it exists
• ☐ Determine who actually filled it out. ⚠ An agent who completed the form and did not ask the question, or wrote an answer the applicant did not give, is the strongest available defense
• ☐ Note the exact wording of each question — ambiguity is construed against the drafter
• ☐ Obtain the paramedical exam and any attending physician statement
• ☐ Request the underwriting file — what did the insurer already know?
• ☐ Check whether the insurer kept accepting premiums after learning the facts
• ☐ Recompute the contestability period from issue OR reinstatement — a reinstatement typically starts a new one
• ☐ Check whether the state requires a causal connection to the cause of death (a minority rule)

☐ Check the suicide clause if applicable — the exact period, and whether a reinstatement restarted it.

☐ Check for a graded death benefit in a simplified-issue or final expense policy. A limited payout in the first two or three years is the policy working as written, not a denial.

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Phase 5 — Denial on an individual policy

☐ Get the denial in writing, with the specific ground and the policy provision relied on.

☐ Request the complete claim file, the underwriting file, and all correspondence.

☐ Calendar every deadline, including any suit limitation in the policy itself, which may be shorter than the state statute.

☐ Test the stated ground:

Ground	Test it by
Material misrepresentation	Phase 4's defenses
Lapse	Was the grace period honored? Was the lapse notice sent to the address on file? Was a secondary addressee designated, as many states require? Was reinstatement offered?
Waiver of premium missed	Was the insured disabled and eligible? A policy that lapsed during a compensable disability should not have lapsed
Exclusion	Read it against the facts — aviation, war, hazardous activity, foreign travel; and for accidental death, intoxication and self-inflicted injury
Coverage never took effect	Was the first premium paid? Was a good-health condition satisfied at delivery?
Beneficiary problem	Phase 7

☐ File a state insurance department complaint. Free, answered in writing, and frequently faster than a demand letter. State authority to regulate insurance is preserved by 15 U.S.C. § 1011 and 15 U.S.C. § 1012.

☐ Send a written demand citing the provision and the facts, and citing the state prompt payment statute by number.

☐ Evaluate bad faith — unreasonable delay, failure to investigate, misrepresenting provisions, seeking rescission without a reasonable basis, demanding documents already provided. Available on individual policies in most states; preempted on group coverage.

☐ Preserve the claim diary and internal notes in any preservation demand.

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Phase 6 — Denial on group coverage

⚠ THE ADMINISTRATIVE APPEAL IS THE TRIAL. The record closes when the appeal concludes.

☐ Calendar the deadline — typically 180 days, and strict.

☐ Request and read the plan document, the summary plan description, and the complete claim file — 29 U.S.C. § 1024.

☐ Identify the exact basis for denial and the plan provision relied on.

☐ Submit EVERYTHING with the appeal:

• ☐ Every medical record
• ☐ Every expert opinion
• ☐ Every affidavit — including from anyone with knowledge of the decedent's intent
• ☐ Every document bearing on the designation
• ☐ Every legal argument, including preemption, plan interpretation, and the standard of review

☐ Quote the plan's discretionary language, or its absence, and address the standard of review — Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101 (1989).

☐ Develop the conflict-of-interest record if the same entity decides and pays — Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008).

☐ Cite the fiduciary standard — 29 U.S.C. § 1104 — and the claims procedure requirements, 29 U.S.C. § 1133, 29 CFR Part 2560.

☐ Confirm receipt in writing.

☐ Then sue under 29 U.S.C. § 1132, understanding the remedy is the benefit, interest, and possibly fees. See Appealing a Health Insurance or Medicare Denial: A Practical Checklist for the parallel process.

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Phase 7 — Competing claims

☐ Identify every possible claimant before the insurer does.

☐ Expect interpleader. The insurer deposits the money, is discharged, and frequently recovers its fees from the fund — 28 U.S.C. § 1335, 28 U.S.C. § 2361, Federal Rules of Civil Procedure § 22.

☐ Understand the shift: the insurer stops being the opponent; the claimants litigate against each other.

☐ Run the scenario:

Scenario	The analysis
Stale designation vs. current family	The named beneficiary usually wins
Ex-spouse named, group coverage	State revocation statute preempted — Egelhoff v. Egelhoff, 532 U.S. 141 (2001). Read the plan for its own provision
Ex-spouse named, individual policy	The state revocation statute probably applies — confirm it covers life insurance
Decree contains a waiver	Not a change of beneficiary — Kennedy v. Plan Administrator for DuPont Savings & Investment Plan, 555 U.S. 285 (2009). Consider a post-payment claim against the recipient
Attempted change never processed	Substantial compliance — mailed and lost is strong; left in a drawer is weak
Slayer claim	Barred in every state; a conviction is not always required
Community property	An interest may exist where premiums were community funds
Estate is beneficiary	Creditors can reach it — Boggs v. Boggs, 520 U.S. 833 (1997) on the limits of transferring plan interests

☐ Move early to control the fund and to consolidate related proceedings.

☐ ⚠ Evaluate settlement among claimants before fees consume the difference. In a modest policy, the fees can approach the amount in dispute.

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Phase 8 — Government and military coverage

☐ Identify the program:

• ☐ Servicemembers' or veterans' group life — 38 U.S.C. § 1965, with anti-attachment at 38 U.S.C. § 1970
• ☐ Federal employees' group life — 5 U.S.C. § 8705. ⚠ The designation must be RECEIVED before death
• ☐ Military Survivor Benefit Plan — 10 U.S.C. § 1448. An annuity, with election windows and a former-spouse deemed election deadline that is missed constantly

☐ Understand the rule: the statute controls, and a state court order purporting to redirect the payment is generally ineffective — Ridgway v. Ridgway, 454 U.S. 46 (1981). A claim against the recipient afterward may still exist.

☐ On any divorce involving these programs: file the new designation and make any required deemed election within the statutory window, and keep the agency's confirmation.

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Phase 9 — Payment, interest, and tax

☐ Request a lump-sum check rather than a retained asset account. Retained asset accounts are lawful and generally payable on demand, but the interest is frequently poor and the account is not insured the way a bank account is.

☐ Request statutory interest from the date of death or from proof of loss. Most states require it; it is almost never paid unless asked for.

☐ Check for an outstanding policy loan, which reduces the death benefit dollar for dollar plus accrued interest.

☐ Tax: death benefits are generally excluded from gross income — 26 U.S.C. § 101 — with a transfer-for-value exception. Interest on delayed proceeds is taxable. Proceeds may be includable in the decedent's estate where the decedent held incidents of ownership.

☐ If the insurer is insolvent, check the state guaranty association and its statutory cap.

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Phase 10 — The designation audit

Do this for every client, in every matter, before they leave.

☐ Every asset that passes by designation:

• ☐ Individual life · group life · accidental death
• ☐ Every retirement account — employer plans and individual accounts
• ☐ Annuities
• ☐ Payable-on-death bank accounts · transfer-on-death securities
• ☐ Health savings accounts
• ☐ Union, association, credit card, and alumni coverage — the most forgotten

☐ The drafting rules:

• ☐ Always name a contingent beneficiary — the most common defect
• ☐ Never name a minor directly
• ☐ Do not name "my estate" — it exposes the money to creditors and to probate
• ☐ Percentages, not dollar amounts
• ☐ Full names and dates of birth
• ☐ Confirm the change was processed, in writing, and keep the confirmation

☐ Review after: marriage · divorce · remarriage · a birth · a death in the family · a job change · a move · an estate plan change · any name change.

☐ On separation from a job, ask in writing about the conversion and portability window — typically 31 days, without evidence of insurability. Nobody tells departing employees, and it is a leading source of uncovered deaths. See Responding to a Termination and Reviewing a Severance Agreement: A Practical Checklist.

☐ Keep a one-page schedule of every policy and account, with insurer, number, and beneficiaries, where the family will find it — see Inventorying and Transferring Digital Assets After Death: A Practical Checklist.

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The deadline table

Item	Window	Consequence
Contestability period	2 years from issue OR reinstatement	Rescission available inside it
Suicide clause	Same period, typically	Premium refund only
Group appeal	Typically 180 days	Exhaustion; the claim
Policy suit limitation	As written — may be shorter than the statute	The claim
State limitation	State period	The claim
Conversion / portability on separation	~31 days	Coverage lost entirely
Prompt payment statute	State period after proof	Statutory interest
Federal employee designation	Received before death	Effectiveness
Survivor Benefit Plan deemed election	Statutory window after divorce	The annuity

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Who does what

The family, first week. Certified death certificates, the policy search, and the written request for the designation on file.

Counsel, at intake. Individual or group — the question that determines everything — plus the issue and reinstatement dates and every deadline.

Counsel, in a group case. The appeal. The value of counsel is highest before the appeal is filed and drops sharply afterward, because the record closes.

Counsel, in a contestable case. The application, the agent's role, and the underwriting file — before responding substantively.

The state insurance department, for any stalled individual claim. Free.

Every client, before leaving. Phase 10.

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Failure modes, ranked

1. Assuming the will or the divorce decree controls.
2. Not determining whether coverage is individual or group.
3. Submitting a thin group appeal and losing on a closed record.
4. Missing the 180-day appeal deadline.
5. Refusing medical authorizations during a contestable investigation.
6. Not obtaining the original application and identifying who filled it out.
7. Not requesting the underwriting file.
8. Computing contestability from the application instead of issue or reinstatement.
9. No contingent beneficiary, so the proceeds fall to the estate.
10. Naming a minor directly, forcing a guardianship.
11. Naming the estate, exposing proceeds to creditors.
12. Accepting a retained asset account without asking for a check.
13. Never requesting statutory interest.
14. Missing the 31-day conversion window on separation.
15. Not confirming a beneficiary change was processed.

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Model communications

Requesting the designation and policy information

"I am [name], a beneficiary of [insured], who died on [date]. A certified death certificate is enclosed.

Before submitting a claim, I request in writing: 1. A copy of the beneficiary designation currently on file, and every prior designation with the date each was received. 2. The policy or certificate, including all riders and endorsements. 3. The date of policy issue and the date of any reinstatement. 4. The face amount and any outstanding policy loan or accrued interest. 5. Whether this claim falls within the contestability period. 6. Whether payment will be by check or by retained asset account. 7. [If employer-provided] The plan document and summary plan description, and any provision addressing revocation of a designation upon divorce.

Please confirm receipt and identify the claim number assigned."

Responding to a contestability investigation

"Enclosed are the requested authorizations. We provide them without waiving any position.

We also request, as part of your investigation: 1. The original application, including any part completed in the applicant's own handwriting. 2. The identity of the agent who took the application and any notes in the agent's file. 3. The paramedical examination and any attending physician statement obtained at underwriting. 4. The complete underwriting file, showing what information the company had when the policy was issued. 5. Any prior application by this insured in the company's files. 6. The date each premium was received, including any received after [date the insurer states it learned of the alleged misstatement].

We reserve the right to respond substantively once these are produced."

Demand on an individual policy

"The claim of [beneficiary] under policy [number] was denied on [date] on the ground that [stated ground], citing [provision].

That ground does not apply because [facts]. [Where applicable: the alleged misstatement was recorded by your agent, who did not ask the question as written; the paramedical examination in your own underwriting file disclosed the condition; premiums were accepted for ___ months after your stated date of discovery.]

We request payment of $______ plus interest from [date of death] under [state prompt payment statute]. A copy of this letter is being provided to the [state] Department of Insurance.

Please preserve the complete claim file, the underwriting file, the claim diary, and all internal notes and communications."

Group plan appeal cover letter

"This is [beneficiary]'s appeal of the denial dated [date] under [plan]. It is submitted within the applicable period.

Enclosed and incorporated into the administrative record are: [itemized list of every record, opinion, affidavit, and document].

The denial is incorrect because [argument]. [Plan section ___ does not contain discretionary language, so review is de novo. / The same entity both decides claims and pays them, a conflict to be weighed under governing law.]

We request that the entire submission be made part of the administrative record and that the full file be provided to us with any adverse determination."

☐ ⚠ Everything the claimant will ever want a court to see must be in this submission.

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The intake sheet

Twelve questions, in this order. They resolve most matters before any research begins.

#	Question	Answer
1	Individual policy or employer group coverage?
2	Date of policy issue; any reinstatement date
3	Date of death — inside two years of either?
4	Who is named on the form actually on file?
5	Is there a contingent beneficiary?
6	Any divorce, and what does the decree say?
7	Any evidence of an attempted beneficiary change?
8	Any competing claimants?
9	Is any beneficiary a minor, an estate, or a trust?
10	What exactly did the denial letter say?
11	Every deadline — appeal, policy suit limitation, state statute
12	Is this government or military coverage?

Evaluation, honestly: a stale designation case against a named beneficiary is usually a losing case, and the family should hear that at the first meeting. A rescission case with an agent-completed application is usually a winning case. A group denial is decided by the quality of the appeal — which is why counsel matters most before it is filed.

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Related Documents

Articles

• The Beneficiary Form Beats the Will: How Life Insurance Money Actually Moves
• Someone Has to Do It: What an Executor Actually Does and How Long It Takes
• Denied: What to Do When a Health Plan Says No
• Who Gets the Password: Digital Assets, Online Accounts, and the Estate You Left in the Cloud

Guides

• Life Insurance Claims and Beneficiary Disputes: A Comprehensive Guide to Contestability, Denials, and Competing Claims
• ERISA: A Comprehensive Guide to Plan Governance, Fiduciary Duty, and Benefit Claims
• Probate and Estate Administration: A Comprehensive Guide from Appointment to Final Distribution
• Health Coverage Denials and Appeals: A Comprehensive Guide to ERISA Plans, Marketplace Coverage, and Medicare

Checklists

• Opening and Administering a Probate Estate: A Practical Checklist
• Appealing a Health Insurance or Medicare Denial: A Practical Checklist
• Inventorying and Transferring Digital Assets After Death: A Practical Checklist
• Responding to a Termination and Reviewing a Severance Agreement: A Practical Checklist

Toolkits

• The Life Insurance Claim and Beneficiary Dispute Toolkit
• The Probate and Estate Administration Toolkit
• The Health Coverage Appeal Toolkit
• The Employee Benefits and Executive Compensation Toolkit