When a life insurance claim is denied in Florida, one of the most important questions is whether the policy is governed by federal ERISA law or by Florida state law. Many families do not realize that life insurance policies provided through an employer are often governed by ERISA, while individually purchased policies are typically regulated by Florida law.
The distinction matters because ERISA and private life insurance policies follow very different rules regarding appeals, evidence, lawsuits, and damages. Understanding these differences can help beneficiaries protect their rights after a denial.
This guide explains the key legal differences between ERISA life insurance claims and private life insurance policies in Florida.
What Is an ERISA Life Insurance Policy?
An ERISA life insurance policy is usually part of an employer-sponsored benefits plan. These policies are governed by a federal law called the Employee Retirement Income Security Act (ERISA).
Most group life insurance policies offered through:
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Employers
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Corporations
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Government contractors (non-government plans)
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Professional organizations
are ERISA-governed plans.
Typical examples include:
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Employer-provided group life insurance
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Supplemental employee life insurance
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Voluntary payroll-deduction policies
However, not all employer policies are ERISA plans. Government employee plans and church plans are often exempt from ERISA.
What Is a Private Life Insurance Policy?
A private life insurance policy is typically purchased directly from an insurance company or agent, rather than through an employer.
Examples include:
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Individual term life insurance
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Whole life insurance
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Universal life policies
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Policies purchased for estate planning
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Policies purchased to protect a family or mortgage
Private policies are generally governed by Florida insurance law, which provides strong consumer protections.
Key Legal Differences Between ERISA and Private Policies
1. The Appeals Process
ERISA Policies
ERISA requires beneficiaries to complete a mandatory internal appeal before filing a lawsuit.
Key features include:
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Strict deadlines (often 180 days)
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Written appeals only
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Evidence must be submitted during the appeal
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Failure to appeal properly can end the claim
If you do not complete the ERISA appeal process correctly, you may lose your right to sue.
Private Policies
Private policies typically do not require a formal appeal before filing suit.
Beneficiaries in Florida can often:
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File a lawsuit sooner
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Conduct discovery
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Take depositions
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Obtain internal insurance documents
This provides much more flexibility.
2. Evidence Rules
ERISA Claims
In most ERISA cases:
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The judge reviews the claim based only on the administrative record
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No new evidence is usually allowed
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No depositions are permitted
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No jury trial
This means the appeal file becomes the entire case.
Private Policies
In Florida private policy lawsuits:
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Discovery is allowed
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Witnesses can be deposed
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Experts can testify
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New evidence can be introduced
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A jury trial is usually available
This often gives beneficiaries a stronger position.
3. Jury Trial Rights
ERISA Policies
ERISA cases are typically:
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Decided by a judge
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Based on written records
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No jury involvement
Private Policies
Private life insurance lawsuits in Florida typically include:
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The right to a jury trial
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Live testimony
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Full litigation procedures
Many families prefer having their case heard by a jury rather than decided solely by a judge.
4. Available Damages
ERISA Policies
ERISA cases usually limit recovery to:
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The policy benefit
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Possible interest
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Attorney's fees in some cases
Punitive damages and emotional distress damages are generally not available.
Private Policies
Florida law may allow recovery of:
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Policy benefits
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Interest
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Attorney's fees in some cases
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Bad-faith damages in certain situations
Bad-faith damages can significantly increase the value of a claim if the insurer acted unreasonably.
5. Legal Standards
ERISA Policies
Many ERISA plans allow the insurer to make decisions under a "discretionary authority" standard.
This can mean:
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Courts give deference to the insurance company
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Denials may be upheld if considered "reasonable"
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Winning can be more difficult
Private Policies
Private policies are typically evaluated under standard Florida contract law.
Courts determine:
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Whether the insurer breached the contract
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Whether exclusions apply
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Whether misrepresentations were material
Judges and juries are not required to defer to the insurance company’s decision.
Why ERISA Claims Require Special Care
ERISA claims are often lost not because the claim lacked merit, but because the appeal was handled incorrectly.
Common mistakes include:
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Missing appeal deadlines
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Failing to submit medical records or proof of eligibility
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Not responding to insurer requests
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Submitting incomplete documentation
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Assuming evidence can be added later
Under ERISA, the appeal stage may be your only chance to build the case.
Signs Your Life Insurance Claim May Be an ERISA Case
Your claim may fall under ERISA if:
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The policy came through an employer
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Premiums were payroll-deducted
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You received a benefits booklet
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The plan is described as a "group plan"
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The insurer requests an "administrative appeal"
When in doubt, a lawyer can review the policy to determine whether ERISA applies.
When a Denial Should Be Challenged
Both ERISA and private life insurance claims may be wrongfully denied for reasons such as:
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Alleged misrepresentation on the application
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Contestability period disputes
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Coverage eligibility disputes
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Policy lapse allegations
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Beneficiary disputes
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Exclusion claims
A denial does not necessarily mean the insurer is correct.
The Bottom Line
The difference between ERISA life insurance claims and private life insurance policies in Florida can determine:
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Whether you get a jury trial
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What evidence can be used
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How appeals work
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What damages are available
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How difficult the case may be to win
Because ERISA claims are governed by strict federal rules, early legal guidance can be critical to protecting your rights.
If your Florida life insurance claim has been denied — especially an employer-provided policy — understanding whether ERISA applies may be the most important step in your case.
Have you or someone you know been denied a life insurance claim? Contact Florida Life Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Miami Attorney Gonzalez-Sirgo directly at jp@yourattorneys.com or by text at (305) 929-8935.
This article is for informational purposes only and does not constitute legal advice.
