Voluntary life insurance claim denied

Early this year (January) my wife was diagnosed with cancer. In early May she went on Family Medical Leave of Absence (FMLA) In late May her employer had open enrollment. There was an option for voluntary life insurance, and she “checked the box.” to get the insurance. The employer then started to deduct the premium from her checks. There were no other follow up notices or any other form of contact from the insurance company or employer.

She passed away in August. She was still getting regular checks from her employer that had insurance premiums deducted. These checks were paid out of the backlog of sick and vacation days.

It gets tricky from here. At the time of open enrollment, she was on FMLA. The Insurance switched to a different company as of July 1st. She was covered (new voluntary policy) as of May 25th by the old company. Then the new company began coverage on July 1st.

The new company denied the claim. Not because of a preexisting illness, but because she was on FMLA when the new company took over, and she hadn’t returned to work. The new company is saying the claim should be made with the old company. The new company also denied the employer provided life insurance policy for the same reason. The employer provided policy is 1x salary and the voluntary is 2x salary, FWIW.

From what I’ve read online, there are protections when going on FMLA. One is that the employee has the same rights and options as any other employee to change insurance options during open enrollment. Just as they would if they were not on FMLA. And remember, this is group.

I also found this. It’s a settlement from the DOL and Prudential. Google the following quote for the full article.

” The settlement with Prudential notes that group policyholders, such as employers, who collect premiums without confirming that the insurer has approved the EOI may be liable for beneficiaries’ death benefit claims. The settlement requires Prudential to notify employers that they should not collect any premiums for coverage that requires an EOI without confirming that Prudential has approved the EOI and, if the employer does collect premiums without getting this confirmation, the employer may be liable to the beneficiaries for any denied benefits claims under the policy. ”

So my question to all the minds smarter than mine here on reddit is, Will I be able to win on appeal? Should I get a lawyer involved?