FEGLI Claim Denial Lawyers

A FEGLI denial from MetLife does not extinguish your benefits. MetLife administers Federal Employees’ Group Life Insurance under contract with the U.S. Office of Personnel Management, but the denial it issues is an administrative decision, not the final word on your claim.

Price McNamara represents federal employees and their families nationwide in FEGLI claim denials. FEGLI falls outside ERISA entirely. It operates under 5 U.S.C. Chapter 87 and has its own appeal structure, evidentiary standards, and path to federal district court. Attorneys unfamiliar with that framework will approach a FEGLI denial with the wrong legal tools.

Contact us for a free case review before your MetLife reconsideration deadline, and we will tell you whether the denial holds up under federal law.

Who Administers FEGLI and Why That Distinction Matters

OPM establishes FEGLI coverage terms under federal law. MetLife administers the program under contract and processes claims as the private carrier.

When a FEGLI claim is denied, MetLife issues the denial, not the federal government. That distinction controls everything that follows. The appeal path runs through MetLife’s reconsideration process before OPM reviews the matter at the federal level.

The legal framework is federal statutory law, not state insurance regulations that apply to private policies, nor ERISA, which governs most private employer group plans. Identifying that distinction at the outset is the first step in any FEGLI denial case.

The U.S. Office of Personnel Management publishes complete FEGLI program information, including eligibility rules, coverage schedules, and enrollment requirements for all four coverage types.

What FEGLI Covers: Four Coverage Types With Distinct Denial Patterns

FEGLI provides four distinct coverage categories. The denial basis and the legal strategy that follows vary by type.

What is Basic coverage under FEGLI?

Basic coverage equals the employee’s annual salary, rounded up to the nearest $1,000, plus $2,000. Enrollment is automatic for most federal employees upon hire unless the employee actively waives it. Premiums are shared between the employee and the federal government.

Basic coverage also provides accidental death and dismemberment benefits. AD&D denials under FEGLI require separate legal analysis. They frequently involve disputes over whether a death or injury qualifies as accidental under the specific policy definition MetLife applies.

What is Option A coverage?

Option A provides a standard additional benefit of $10,000. Like Basic, enrollment is available without medical underwriting during initial eligibility windows. Employees who miss those windows must provide evidence of insurability for any later election.

What is Option B coverage?

Option B allows employees to elect one to five times their annual salary in additional coverage. This option generates the most evidence of insurability disputes.

Employees who attempt to increase Option B coverage outside of an open season or qualifying life event must provide medical evidence that MetLife reviews and can deny. A denial based on medical underwriting requires a different legal strategy than a denial based on eligibility or lapse.

What is Option C coverage?

Option C covers eligible family members: a spouse and unmarried dependent children. Coverage amounts follow a set schedule rather than salary. Denials frequently turn on whether the deceased family member met FEGLI’s definition of an eligible dependent at the time of death.

The OPM FEGLI Handbook covers all four coverage types in detail, including the evidence of insurability requirements and open season rules that generate a significant share of FEGLI disputes.

Why Do FEGLI Claims Get Denied?

FEGLI denials follow recurring patterns. Identifying the denial basis determines the legal strategy.

Was coverage in force at the time of death?

Coverage lapse is the most common denial basis in FEGLI cases. Federal employees who separate from service, retire, or reduce their hours may see coverage change automatically depending on which elections were in place.

Retired federal employees can continue FEGLI coverage under specific election conditions made before retirement. Employees who separate before retirement may convert to an individual policy within 31 days. A denial based on post-separation coverage requires a close review of the employment record, the election history, and whether the conversion right was properly offered and processed.

Did the employee inadvertently waive coverage?

Employees who waive Basic or optional coverage at hire cannot re-enroll without a qualifying life event or open season. If personnel records show a waiver the employee does not recall signing, or show an administrative error in how the waiver was recorded, that becomes a factual and legal dispute.

OPM and federal courts have the authority to resolve those disputes. The firm has handled cases where administrative processing errors produced coverage gaps that the employee had no knowledge of.

Is there a beneficiary designation conflict?

Federal employees designate FEGLI beneficiaries on OPM Form SF-2823. When no designation is on file, benefits are paid according to the statutory order of precedence: surviving spouse first, then children, then parents, then the estate.

A divorce does not automatically revoke a prior designation under federal law. When competing claimants exist, MetLife and OPM may delay payment or require a court order before disbursing benefits. Those situations require legal action, not correspondence with the carrier. The OPM beneficiary designation page details the SF-2823 requirements and how the order of precedence applies.

Was the death classified as non-accidental?

FEGLI Basic and Option A both include AD&D components. MetLife applies its own definition of accidental death in processing those claims. Deaths involving any pre-existing medical condition or concurrent health event are sometimes incorrectly classified as non-accidental.

That classification requires direct challenge with medical and forensic evidence, not a general restatement of the treating physician’s records.

MetLife’s reconsideration deadline is stated in the denial letter. A case evaluation before that deadline passes preserves every appeal option available under the statute.

The Three-Stage FEGLI Appeal Process

FEGLI denials follow a structured appeal path distinct from both ERISA and private insurance disputes.

Stage 1: MetLife Reconsideration

The first formal appeal after a denial goes directly to MetLife as a reconsideration request. This stage is where additional medical documentation, employment records, legal arguments, and specialist opinions should be submitted. The reconsideration record shapes everything that follows at the OPM and federal court stages.

Most claimants treat the reconsideration request as an informal letter asking MetLife to take another look. The firm does not. The reconsideration is built as a legal record designed to address the denial basis directly and withstand scrutiny at every subsequent stage.

Stage 2: OPM Review

If MetLife upholds the denial on reconsideration, the claimant can appeal to OPM. OPM reviews FEGLI disputes under its authority as program administrator under 5 U.S.C. Chapter 87. OPM’s review is independent of MetLife’s determination and has produced reversals of MetLife denials that were initially upheld.

Stage 3: Federal District Court

If OPM upholds the denial, the claimant has the right to challenge the decision in federal district court under 5 U.S.C. § 8715. The court reviews OPM’s determination against the administrative record.

What was submitted at the MetLife and OPM stages directly affects what the federal court has to work with. Building it correctly from the start matters more than any subsequent argument.

What Happens to FEGLI Coverage After Federal Employment Ends

FEGLI coverage does not automatically continue when a federal employee leaves service. The options available depend on the circumstances of the separation.

Employees who retire under an immediate annuity with at least five years of FEGLI coverage may continue Basic coverage into retirement, with reductions beginning at age 65 unless the employee elected no-reduction coverage during active service. Optional coverage continuation follows separate election requirements.

Employees who separate before retirement have 31 days to convert any FEGLI coverage to an individual policy without medical underwriting. Missing that 31-day window eliminates the conversion right permanently.

Denials arising after separation frequently turn on whether the conversion right was properly offered, documented, and processed by the employing agency. The firm reviews agency-side personnel records as part of every post-separation coverage dispute.

Get a free case review before your MetLife or OPM deadline passes.

How the Firm Handles FEGLI Claim Denials

Where Every FEGLI Case Starts

The evaluation begins with the denial letter, the coverage election history, the beneficiary designation on file, and the employment records that establish coverage status at the time of death or claim. The firm identifies whether the denial basis holds up under 5 U.S.C. Chapter 87 before any response is submitted to MetLife.

How the Firm Builds the Reconsideration Record

The reconsideration request to MetLife is a legal record, not a letter. The firm develops the factual and legal arguments that address the denial basis directly, supported by medical evidence, employment documentation, and specialist opinions where required.

For AD&D denials involving cause-of-death disputes, the firm retains forensic pathologists and the relevant medical specialists. MetLife frequently assigns generalist reviewers to evaluate claims that require specialist analysis. Credentialed specialists who engage MetLife’s stated rationale directly carry significantly more weight than general rebuttal letters.

What the Firm’s Background Produces in FEGLI Cases?

FEGLI falls outside ERISA. Attorneys who handle ERISA cases but have no FEGLI experience routinely misidentify the applicable legal framework, apply the wrong procedural rules, and miss the administrative deadlines specific to the FEGLI appeal structure.

1. Price McNamara practices exclusively in insurance claim denials, including life insurance, disability, and AD&D matters. The former insurance defense background the firm brings to each FEGLI case reflects years of understanding how carriers build denials, which arguments hold up under federal court review, and where MetLife’s positions are most vulnerable.

The evaluation costs nothing and commits to nothing. What it produces is a clear answer to whether the denial holds up under federal law.

How Does the Fee Structure Work for FEGLI Cases?

The firm takes FEGLI cases on contingency only. No fees are owed unless the firm recovers benefits for the family.

We front all out-of-pocket costs, including specialist fees, record retrieval, and federal court filing costs. If the case is not successful, those costs are not reimbursed by the client. Instead, the firm covers them.

The contingency fee carries a hard dollar cap. A large FEGLI recovery does not generate an unlimited percentage fee. The fee does not increase if the case proceeds through OPM review or into federal district court.

Under applicable federal law, courts may award attorney fees to prevailing claimants in certain FEGLI actions. Any fees the court awards go to the client, not to the firm.

FEGLI Claim Denial Questions Answered by Our Attorneys

How long does a FEGLI beneficiary have to request reconsideration from MetLife?

The reconsideration deadline is stated in the denial letter. MetLife sets its own deadline for the initial appeal stage, and OPM imposes separate deadlines at the federal review stage. Missing either deadline can limit the options available at the next stage. Review the denial letter immediately and seek legal review before submitting anything to MetLife independently.

Does FEGLI Basic coverage pay benefits when the death is by suicide?

FEGLI Basic coverage does not contain a suicide exclusion. Optional coverage under FEGLI contains a time-limited suicide exclusion for newly elected coverage. The specific coverage type and the date of the coverage election determine whether any exclusion applies. A denial citing suicide as a basis should be reviewed by an attorney familiar with 5 U.S.C. Chapter 87 before any response is submitted.

What is the FEGLI living benefit, and when can it be denied?

The FEGLI living benefit allows a terminally ill federal employee with a life expectancy of nine months or less to accelerate a portion of Basic coverage as a lump-sum payment. Denials of living benefit claims are typically based on the medical documentation supporting the terminal diagnosis. The same MetLife reconsideration and OPM appeal process that applies to death benefit denials also applies to living benefit denials.

Can a former spouse collect FEGLI benefits after a divorce?

A divorce does not automatically revoke a FEGLI beneficiary designation under federal law. If a federal employee named a spouse, later divorced, and never updated OPM Form SF-2823, the former spouse may retain the legal right to the benefit. These disputes require resolution through OPM or federal court. The statutory order of precedence governs only when no valid designation exists.

Is FEGLI available to United States Postal Service employees?

Yes. USPS employees are federal civilian employees and participate in FEGLI under the same program terms as other federal workers. The same four coverage types, enrollment rules, evidence of insurability requirements, and three-stage appeal process apply to postal workers and their families.

Before the Reconsideration Deadline Passes

FEGLI benefits represent a commitment made and funded through years of federal service. A MetLife denial is an administrative determination, not a legal judgment, and the federal appeal process exists specifically to challenge it.

Price McNamara evaluates FEGLI cases at no charge. The evaluation starts with the denial letter and the coverage records, identifies whether the denial basis is legally defensible, and determines which appeal options remain open. No fees are owed at any stage unless the firm recovers benefits.

Contact us before the reconsideration or OPM deadline passes.