Handling Your Denied AD&D Claim
If you submitted an accidental death and dismemberment (AD&D) claim for benefits and your insurance company has denied it, you may feel at a loss with what to do next. There is a good chance you will still be able to recover your AD&D benefits. However, there are also things you may think will help your claim that may in fact harm your claim and reduce your ability to recover AD&D benefits. Below are some things to do and to avoid doing to ensure the greatest likelihood of being awarded your AD&D benefits.
• Consult with an experienced AD&D/accidental death insurance attorney to understand the claims process, the accidental death insurance claim denial and your rights and obligations
• Understand that it is in the insurance company’s best interest to deny claims as opposed to paying them out. Do not be surprised if the insurance company finds any basis it can to deny your claim, no matter how unreasonable that basis may seem
• Gather any and all AD&D insurance policy documentation
• Gather any medical, hospital, or autopsy records that pertain to your case, including a death certificate, police report, or incident/accident reports
• Consider hiring your own experts as you may need an expert opinion (e.g., a pathologist to perform an autopsy or other examination separate from the insurance company; an accident reconstruction expert to examine the nature and cause of the accident
• Contact potential witnesses
• Assuming that just because the death certificate lists the reason for death as accidental that the insurance company will approve your AD&D claim
• Talking to or providing any information to your insurance company without first speaking to an attorney
• Attempting to fight an insurer’s accidental death insurance denial on your own. Instead, talk to an experienced AD&D insurance lawyer who can guide you.
Common Reasons Accidental Death And Dismemberment Claims Are Denied
Insurance companies often deny AD&D claims for many reasons, but the most common two reasons are that the death or injury was not caused by an accident, or that coverage for the death or injury is excluded in the policy. AD&D claims are also commonly denied for reasons like failing to pay premiums, or because the death occurred too long after the accident, and it is no longer covered under your AD&D policy.
When Death Or Dismemberment Was Not Caused By An Accident
Because AD&D policies are only designed for “accidental” death and injury, a death or dismemberment caused by anything other than an accident will likely not be covered. However, the exact cause of death is not always obvious and there often exists a distinction between a “contributing” cause and a cause that “substantially” contributes to the death or dismemberment. This distinction is critical in most cases and understanding how and when to apply this distinction can only be made by an experienced accidental death insurance claim attorney. Insurance companies will try to avoid these distinctions when they deny accidental death insurance claims.
When Coverage For Death Or Dismemberment is Excluded By The Policy
Your AD&D policy has a list of exclusions to coverage, which identifies situations under which the policy does not cover accidental death or dismemberment. Some typical exclusions are death caused by illegal drug overdose taken without a prescription, death or injury caused by driving under the influence of drugs or alcohol, and suicide or a medical condition contributing to the accidental death. Policy exclusions vary between different insurers and policies. To avoid being caught off guard by a policy exclusion, it is best that you read and fully understand what your policy covers and what it excludes. But even reading the policy exclusions may not be indicative of the outcome as legal decisions and the laws in several states may alter the interpretation of the policy exclusion. Only an experienced AD&D attorney will be able to guide you on the legal interpretations.
How An Experienced AD&D Insurance Lawyer Can Help You If Your Accidental Death And Dismemberment Claim Is Denied
We have discussed above several circumstances in which you will want to consider hiring an experienced accidental death insurance claim attorney. If your claim was denied, the first thing to understand is that a claim denial is not the end of the line. Under most circumstances, you have the right to appeal the insurance company’s denial of your claim. If you did not consult an attorney before filing an initial claim, now is the time to consider hiring a qualified AD&D claim attorney. Be aware that you will have a deadline by which the insurance company must receive your appeal, which may vary from state to state or which may be determined by a federal law called ERISA. If your AD&D claim was denied and you are interested in appealing the denial, the best plan of action is to start by contacting an experienced AD&D insurance lawyer who will be able to help you understand why your initial claim was denied and ensure you have the best chance of receiving the benefits to which you are entitled under your AD&D policy.
The highly experienced AD&D insurance attorneys at McKennon Law Group PC provide free consultations so you can get your AD&D insurance questions answered. And if you choose to pursue legal action, McKennon Law Group PC has a team of experienced AD&D insurance attorneys ready to assist you in recovering the benefits you are owed under your AD&D policy.