Sources and Citations

State insurance regulatory publication providing plain language definitions of standard life insurance terms. Select definitions in the askforlenny.com glossary were informed by this reference and rewritten in the author's voice. Terms consulted: Dividend, Policy Loan, Reinstatement, Settlement Option, Variable Life Insurance.

State insurance regulatory publication providing plain language definitions of insurance terms across product lines. Select definitions in the askforlenny.com glossary were informed by this reference and rewritten in the author's voice. Terms consulted: Activities of Daily Living, Conditional Receipt, Endowment Insurance, Insurable Interest, Joint Life Policy.

"My dad died from cancer a couple of months ago. He took out a life insurance policy through work, but they're denying the claim because they're saying they don't have an 'Evidence of Insurability'. The premiums have been coming out of his check since he signed up for it, but he was never notified that he needed to fill out the EOI."

"Husband laid off due to downsizing lost his life insurance. QLE doesn't apply to life insurance. We missed it when initially reading it."

"Last time I saw the cost to port group supplemental life to individual, it was off the charts high."

"I've always paid for the max for supplemental life insurance through my company to make sure my family will be taken care of if anything were to ever happen. This year was different. Last year, I was diagnosed with pulmonary sarcoidosis. The form asked many more questions which I answered truthfully. This year they denied my supplemental insurance just because I got sick."

Federal appellate opinion affirming a $314,000 award for an employer's breach of fiduciary duty. The employer accepted premiums for supplemental life insurance over six years without ever submitting the Evidence of Insurability, then the claim was denied after the employee's death.

Federal district court surcharged the plan administrator $750,000 under ERISA Section 502(a)(3) for failing to include conversion forms and deadlines in an FMLA packet issued to a terminally ill employee.

U.S. Department of Labor settlement with a major group life carrier. Requires the carrier to reprocess denied claims where the employer had collected premium for an extended period without confirming Evidence of Insurability.

U.S. life insurers paid approximately $89 billion in life insurance death benefits in 2024.

Published BLS data indicates that a large majority of workers with group life insurance pay no premium for the base employer sponsored coverage. Underlying data is from 2020.

Published carrier rate tables used to describe approximate retail pricing for a healthy non smoker at age 40 and age 50, $500,000 twenty year term. Figures on the article page are rounded. This is not a Lenny quote and is not an offer for coverage.

The first $50,000 of employer paid group term life insurance is excluded from gross income. The value of coverage above that amount is imputed income valued using IRS Table I rates.

Federal regulation requiring ERISA plans to give claimants at least 180 days to appeal an adverse benefit determination and to follow a specified claims procedure.

Supreme Court decision establishing that equitable remedies under ERISA Section 502(a)(3) include surcharge, equitable estoppel, and reformation when a plan fiduciary breaches its duties.

The Medical Information Bureau (MIB) is a non-profit membership corporation that operates a coded database used by member life insurance companies during the underwriting process. Consumers may request a copy of their MIB file and dispute inaccurate entries.

Section 612 of the Fair Credit Reporting Act (15 U.S.C. 1681j) entitles consumers to one free disclosure of their consumer file per 12-month period from each consumer reporting agency. MIB Group is a consumer reporting agency for purposes of the FCRA. Consumers may request their MIB file free of charge once per year.

Life insurance carriers may access a consumer's prescription fill history through third-party prescription data services (such as Milliman IntelliScript) as part of accelerated or standard underwriting. These services are governed by the FCRA and consumers have the right to request a copy of their prescription history report.

The National Association of Insurance Commissioners operates a free Life Policy Locator that allows consumers to submit a search request to participating life insurance companies simultaneously. Participating carriers search their own records and, if a match is found on the deceased person's life, contact the submitter directly within 90 business days. Submission requires the deceased's name, date of birth, Social Security number, and date of death.

The National Association of Unclaimed Property Administrators operates unclaimed.org, a free multi-state search tool for unclaimed property including life insurance benefits. When a life insurance benefit goes unclaimed after a policyholder's death, state law requires the carrier to turn those funds over to the state's unclaimed property division after the applicable dormancy period. Funds held by the state do not expire.

MissingMoney.com is a supplemental unclaimed property search tool that covers state databases not always captured in a single search. Recommended as a companion search to unclaimed.org. Free to search.

The U.S. Department of Labor's EFAST2 system makes publicly available the annual Form 5500 filings submitted by employers for their employee benefit plans, including group life insurance plans. Searching by employer name surfaces plan administrator contact information and carrier names, useful when HR records are no longer accessible.

U.S. life insurers paid $88,525 million ($88.5 billion) to life insurance beneficiaries in 2024. The ACLI's own narrative text rounds this to "$89 billion." Individual policies accounted for $66,200 million (75%); group policies $22,061 million (25%); credit life $264 million. This was a 0.6% decrease from 2023, when $89,072 million was paid. Data represent NAIC 2024 statutory filings covering approximately 93% of U.S. life insurer assets.

Of all life insurance claims in dispute during 2024, $242,615 thousand ($242.6 million) remained resisted at year end. The ACLI's own narrative text rounds this to "$243 million." This figure includes new claims and all prior claims still unresolved. Reasons for dispute include material misrepresentation, suicide within the contestable period, and no proof of death, among others. During 2024, $182,958 thousand ($183 million) in disputed claims was paid.

How the "less than three tenths of one percent" figure is calculated:
Total paid to beneficiaries (Table 5.2): $88,525,000 thousand
Amount resisted at year end (Table 7.7): $242,615 thousand
$242,615 ÷ $88,525,000 = 0.00274 = 0.274%
0.274% is less than 0.3%, which is three tenths of one percent. ✓

Note: the $242.6 million figure is a face amount of policies in dispute, not a count of individual claims. The 3,718,000 total claims figure is from Table 5.8 of the same publication.

In 2024, 3,718,000 life insurance policies and certificates resulted in death benefit payments totaling $88,525 million. Individual policies: 2,635,000 claims paying $66,200 million. Group certificates: 1,042,000 paying $22,061 million. Credit life: 42,000 paying $264 million. Historical context: payments peaked in 2021 at $100,188 million (COVID related), declined to $91,670 million in 2022, $89,072 million in 2023, and $88,525 million in 2024.

Analysis of CMS transparency data covering 162 HealthCare.gov issuers in 2021. Key findings: nearly 17% of in-network claims were denied (48.3 million out of approximately 290 million claims submitted). Individual insurer denial rates ranged from 2% to 49%. Less than two-tenths of 1% of denied claims were appealed (90,599 appeals out of 48.3 million denials). Of internal appeals, issuers upheld 59% of denials, meaning 41% were reversed in the enrollee's favor.

Survey of 1,000 practicing physicians conducted December 2024. Key findings: physicians and their staff spend an average of 13 hours per week completing prior authorizations (physician and staff time combined). 94% of physicians report that prior authorization has a somewhat or significant negative impact on patient clinical outcomes. The average physician practice completes 45 prior authorizations per physician per week.

Federal inspector general audit of 15 selected Medicare Advantage Organizations. Key finding: 13% of prior authorization denials and 18% of payment request denials met Medicare coverage rules, meaning those services likely would have been covered under traditional Medicare. The report concluded that these denials inappropriately delayed or denied access to medically necessary care. Data sample: denials issued during the first week of June 2019.