Life Insurance Claim Denial: Accidental Death & Dismemberment (AD&D)
AD&D (Accidental Death & Dismemberment) insurance is optional insurance coverage that a person may purchase. A person may purchase AD&D insurance to supplement life insurance coverage. Some employers offer AD&D coverage as part of their employee benefits package. AD&D coverage may be purchased as a standalone policy or as a rider to a life insurance policy.
As with other types of insurance coverage, insurance companies attempt to undervalue AD&D claims or deny claims, if possible. Unfortunately, many AD&D claims are denied without merit. If your AD&D claim is denied, contact a life insurance attorney in Kansas City immediately. The steps you take after receiving a denial of an insurance claim can make a significant difference in whether you receive the compensation you deserve under your insurance contract.
There are often very short deadlines (many times, just 60 days) to gather and submit all factual and legal support to appeal a wrongful denial of a life insurance or AD&D claim. You must act immediately to present the strongest case possible. Call us today at 816-203-0143. We'll review your denial letter for free and provide a strategy on how to fight back.
Why Do Life Insurance Companies Deny AD&D Claims?
AD&D compensates victims for covered claims related to accidental death and dismemberment. Not all deaths or dismemberments are covered under the terms of the policy. A life insurance company could have a valid, legal reason for denying an accidental death or dismemberment claim. However, some insurance companies act in bad faith by denying life insurance claims that the insurance company knows to be valid.
Some of the reasons that an insurance company may give for denying an AD&D claim include:
- Not an Accidental Death — The death resulted from a cause that was not accidental, such as an illness or pre-existing medical condition. In some cases, it can be challenging to prove that the death was the direct result of an accident. If the person had a pre-existing condition, or there are other factors related to the death, the insurance company may argue that the accident was not the primary cause of death.
- Intentional Deaths or Dismemberments — The company may argue that the death or dismemberment was the result of an intentional act. For instance, the person committed suicide, or another person intentionally murdered the insured. By arguing that the death was intentional, the insurance company shifts the burden of proving the death was accidental to the beneficiary of the AD&D policy.
- Exclusions From Coverage — An AD&D policy may have several exclusions from coverage. Exclusions are situations in which the insurance company is not responsible for paying benefits even though the insured may have died or lost a limb. For example, fatalities related to drunk/impaired driving, driving under the influence of alcohol or taking illegal drugs may not be covered under an AD&D policy.
- Medical Care or Medications Caused the Death — If the person received medical treatment after an accident, the company might claim that the treatment or lack of treatment resulted in the death. When death does not occur immediately or within a short period, the insurance company may argue that the death was not caused by the accident, but by other mitigating circumstances.
- No Coverage — In some cases, the insurance company may claim that the AD&D policy lapsed for failure to pay premiums. For employer-based policies, the company may claim that the employee had not worked for the employer long enough to qualify for coverage.
- Blaming the Insured — An insurance company may blame the insured for causing the death or dismemberment. The company may deny the AD&D claim stating that the insured’s negligence or recklessness caused the death or dismemberment, thereby voiding the insurance coverage.
What Should I Do If the Life Insurance Company Denied My Claim?
Before making an AD&D claim, read your insurance policy carefully. Make notes of the coverage amounts, exclusions, claim deadlines, and other information relevant to filing a claim. Gather all documentation related to the accident, including medical records, witness statements, and accident reports. Keep copies of all documents related to the accident and claim.
Follow the instructions for filing a claim carefully. Make careful notes of each conversation with the insurance company, including the date, time, person’s name, and details of the conversation. Detailed records are vital for an AD&D claim.
If the insurance company denies your claim, you usually have a very short period to fight back. Many AD&D policies are governed by a federal law known as ERISA. ERISA governs most employer-sponsored group health and benefit plans. These plans may include term life, A&D and long-term disability policies for employees. Regardless of the type of plan, ERISA gives an unfair advantage to the insurance company and sets out specific rules and timelines for filing an administrative appeal of a denial. These appeals are required under ERISA prior to filing a lawsuit, and if you fail to submit all relevant legal and factual support for your position, you are usually barred from introducing it later at trial.
AD&D appeals and lawsuits can be complicated. Fighting a large insurance company can be overwhelming, time-consuming, and costly for an individual. It can be beneficial and wise to contact a Kansas City life insurance claims attorney to discuss your claim.
Contact a Kansas City Life Insurance Claims Lawyer for More Information
Don’t let an insurance company take advantage of you and your family. The Law Office of Kevin J. McManus helps individuals and families fight for fair compensation after a denial under Accidental Death & Dismemberment insurance policy. We assist beneficiaries and policyholders in filing initial claims, fighting for full payment of policy amounts, and appeal of AD&D denials.
Call 816-203-0143 for a free consultation with a Kansas City life insurance claims attorney near you.