Hundreds were denied life insurance benefits. Could it have been prevented?

June 29, 2023
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Hundreds of families who had paid life insurance premiums were denied millions of dollars in death benefits. Finch could have prevented it.

Hundreds of employees were just denied life insurance benefits. Finch could have prevented it from happening.

In May 2023, the Wall Street Journal reported that hundreds of families who had diligently paid life insurance premiums were denied millions of dollars in death benefits. This unfortunate outcome stemmed from paperwork missteps made by both employers and insurance companies.

However, this situation could have been avoided with the assistance of Finch’s unified API, which bridges data silos to connect mission-critical employment data. In this blog post, we’ll delve into what happened and how Finch can help prevent such issues from happening again.

What exactly happened?

The report revealed that a leading life insurer had made errors resulting in over 200 denied claims, amounting to as much as $7 million, in recent years. The denial of these claims left families in a distressing situation, as they were rightfully expecting financial support during a difficult time.

Why were their claims denied?

Despite diligently paying life insurance premiums, employees were denied their life insurance benefits due to "paperwork errors" made by their employers. These errors specifically involved the failure to submit "evidence of good health" questionnaires, which are often required for employees to qualify for supplemental insurance beyond the basic coverage. As a result, the life insurance company did not approve the employees for supplemental life insurance, and their claims were denied.

For background, group life insurance is a common employee benefit, with coverage typically ranging from 1-2 times an employee's salary. Employers often offer supplemental insurance beyond the basic coverage, and employees contribute to it through their paychecks. However, to be eligible for this additional coverage, employees must fulfill certain criteria.

Who's responsible for this outcome?

According to the carrier, the responsibility lies with employers, who must submit the required “Evidence of Good Health” form.

Employers often handle administrative tasks, including the calculation of premiums and ensuring that employees complete the necessary health forms for additional coverage. This allows insurers to offer life insurance to workers at relatively low costs and has been the standard practice for years according to the American Council of Life Insurers.

But doesn’t the carrier also bear some responsibility too? While it may seem logical that the carrier should be accountable for the payouts since they accepted the premiums, the truth is carriers are often encumbered by siloed systems and flawed processes—which lead to clunky and error-prone data exchanges with employers. For example, premiums are often aggregated rather than individually specified in employer-administered programs, making it difficult to link specific premiums to individuals. Furthermore, some carriers only conduct audits when a death claim is filed, rather than beforehand.

The courts say both parties have a role to play in preventing these issues going forward. Carriers must improve communication with employers regarding their responsibilities, and employers must submit the appropriate paperwork on behalf of their employees. In this case, the carrier  has agreed to notify its employer clients that they must confirm the approval of health forms for workers' supplemental coverage before deducting premiums from paychecks. At the same time, if employers fail to fulfill their obligations, they may be held liable for payouts to the beneficiaries.

At the end of the day, it’s about miscommunication between the carrier and employers, and inadequate sharing of data between them. And this problem isn’t unique to this case. Insurance carriers everywhere struggle with similar issues when it comes to collecting and managing data on individuals through their employer. In many instances, even leading insurers don’t have access to the technology they need to effectively tackle these challenges.

Moving forward, who will be held accountable?

The responsibility for preventing such issues is increasingly falling on employers and their employees. Employers must be more diligent in filing paperwork, ensuring eligibility criteria are met, and obtaining approval for coverage before collecting premiums from employees and forwarding them to insurance carriers.

Why hasn't this been automated?

Despite the advanced technology we have access to in 2023, the administration of employee benefits still poses challenges. Sharing employee data between systems is still in its infancy and although thousands of apps have been created over the past decade to help employers manage employee data—no underlying infrastructure exists to connect all this data together. In fact, with over 5,700 employment systems in existence today, the market remains highly fragmented, making it nearly impossible for a third-party solution to solve the problem comprehensively.

Consequently, employers are forced to manually enter and transfer employee data between multiple systems. This manual process is time-consuming and prone to error. And to make matters more complicated, each system has its own rules and standards regarding data formats, leading to inconsistencies and compatibility issues when transferring information. As a result, crucial details often fall through the cracks, causing problems such as the denial of life insurance benefits.

Employers need to demand that their HR systems communicate with each other, eliminating the need for manual data entry and ensuring a streamlined process. It's time for the industry to embrace interoperability and leverage its buying power to make automated employee benefit administration a reality.

How can Finch help solve this problem?

Finch provides the vital infrastructure to connect disparate systems, facilitating secure and efficient movement of sensitive employment data between them. By integrating with Finch, third party organizations like insurance carriers gain direct access to relevant employee data from an employer's systems of record, such as HRIS and payroll software. This connectivity is extremely powerful for companies with the fiduciary duty to report on individual employee evidence of insurability—streamlining the exchange of information, and making it easier for carriers and employers to exchange employee data accurately.

For example, after integrating with Finch, carriers can prompt employers to connect their employment systems of record, granting permission for the carrier to access relevant employee data. The carrier can then automatically pull the required information, evaluate eligibility and approve coverage. Employers can proceed to collect and pay premiums, ensuring employees receive the coverage they are entitled to.

However, it’s important to note that no two implementations ever look the same. That’s why, at Finch, we’re here to help advise.

What’s the bottom line?

Simple administrative errors shouldn’t be the reason life insurance benefits are denied. And with employment data that’s connected and programmable, they don’t have to be. In fact, everybody wins with effective data sharing. Carriers and employers can both ensure they’ve done their part, reducing their risk of future litigation, and employees get their rightful benefits, at a time when they need them most.

To learn more about how Finch can help prevent life insurance benefit denials, reach out to our sales team.

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