Voluntary Group Life "Active At Work" provision

[Guest AZ-Ins-Agent]

I am researching if it is customary for ALL insurance companies writing voluntary group life policies to include an "Actively At Work" provision. A TPA recently changed insurance companies for a Voluntary Group Life policy and provided an open enrollment period. During the open enrollment period an employee who was on medical leave for a terminal illiness increased the limits of his coverage during the open enrollment period. He died before he returned to work and met the "Actively At Work" requirement. His estate is now suing the TPA and argues that the TPA should have selected an insurance company that did not have this provision. I am trying to determine if there is ANY insurance company that provides voluntary group life coverage that does NOT have this provision. If there is one... I have not been able to find it. Thank you - Jim

[LRDG]

One of the principal underwritting considerations for most group coverage is the 'actively at work' provision. Employees 'actively working' includes underwritting assumptions that the employees are not at death's door, and rates are priced accordingly.

The application usually has the actively at work for the past 30/60/90? days question vs. the lengthy medical history application for fully underwritten policies.

Unless s/he lied about being actively at work, if the insurance company issued a policy and/or accepted premium payments, simply returning the premiums may not be an option. Many states enforce insurance laws requiring benefit payment once Insurance company premiums are billed/paid and a policy has been issued or is pending issuence. Returning premiums may not be an option.

Terminating group coverage that would have otherwise covered the employee could be a stronger legal argument.

[Guest jeffbolmeyer]

AAW is a one of the most common provisions found in all carriers GTL plans. What eventually happened with this claim?

[Guest jeffbolmeyer]

Did the prior VGTL policy have a WOP or Extended Death provision? You mentioned the deceased applied to increase their death benefits with the new carrier. Does this mean the deceased was covered for a lesser amount of VGTL insurance by the prior carrier? You will have to file the claim with the prior carrier so they can make a determination, but if the prior carrier's VGTL policy did contain a WOP or Extended Death Benefit, its possible that the prior carrier will pay their lower VGTL benefit? If the deceased was not covered for VGTL by the prior carrier, given the information provided, there is no VGTL carrier I am aware of who would insure the deceased and the deceased's estate would be entitled to a return of premiums paid.