California Accidental Death and Dismemberment Insurance (AD&D) Lawyers

With Offices in Newport Beach, San Diego, San Francisco & Los Angeles

Accidental death and dismemberment insurance policies promise financial security after a loved one dies as the result of an accident or accidental bodily injury. These policies also promise to pay an insured a specific amount of money if the insured suffers from some type of dismemberment or any other significant injury.

Unfortunately, insurance companies often deny accidental death and dismemberment policy claims and break their promise to provide you with the benefits you thought you had secured. Insurers have a financial incentive to collect premiums and pay out less in benefits, which will increase their bottom line. This conflict of interest can motivate them to improperly deny your accidental death or dismemberment policy claim. With decades of experience in fighting insurance companies, McKennon Law Group PC in California is ready to represent you.

What is Accidental Death And Dismemberment Insurance?

Accidental death and dismemberment (AD&D) is a type of insurance policy that pays cash benefits if the insured dies or suffers a serious dismembering injury as a direct result of an accident.

AD&D is often purchased through an employer and is typically provided to supplement life insurance policies. Unlike life insurance coverage, which provides coverage for all types of death, AD&D policies only provide insurance benefits for deaths or dismemberment caused by accidents. That means AD&D will usually not pay out for death caused by suicide, illness, disease, and other natural causes. Unfortunately, the “accident” or “accidental bodily injury” requirement leads to insurance companies trying to avoid paying claims by saying the policyholder’s death was not caused by an accident covered by the policy or that the death or dismemberment was in part caused by a sickness or medical condition and thus not covered. Claim denials can be appealed, but you will need a knowledgeable accidental death insurance attorney to guide you through this complicated legal process.

How Do You File a Claim?

Filing an AD&D claim will usually require the following steps:

Notify the insurance company of the death.
Obtain and accurately complete the claim forms.
Gather supporting documents, which usually include:
- The death certificate
- Medical records
- Police or accident report
- Proof of relationship to the policyholder
- Employment records if the policy is employer-sponsored
- Autopsy report
- Toxicology report
Submit your claim package.
The Insurance company reviews your claim.
They will approve or deny the claim.
File an appeal if denied.
If the appeal is denied again, you can file a lawsuit in state court for non-ERISA policies and in federal court for ERISA policies. The judge or jury will review the facts and decide whether the denial was legally justified.

This process is riddled with administrative deadlines. Missing a deadline or making a mistake can result in your inability to legally pursue your case. Working with an attorney will make this process much easier for you.

Why Would Your Claim Be Denied?

The first step toward understanding your claim denial is understanding the legitimate reasons your claim may have been denied. All AD&D policies come with specific exclusions that can complicate claims. If your claim involves one of the following situations, it will likely be denied.

The death was not an accident but was from illness or natural causes. Even if an accident triggered a condition like a heart attack or stroke, the insurance company may still deny coverage.
Alcohol consumption or drug use caused or contributed to the accidental death.
Drug overdose due to prescription drugs or illegal narcotic use contributed to the accident.
The accident was caused by taking non-prescribed prescriptions, consuming illegal drugs, or the misuse of drugs combined with alcohol.
The death occurred during the commission of a crime.
The death was not accidental but was instead due to “natural” causes or “natural” causes contributed ed to the accident.
Medical treatments of illnesses or diseases caused or contributed to the death.
The death was a suicide.

Accidental death and dismemberment claims are difficult to navigate because there are so many non-valid reasons that insurance companies use to deny claims.

They may also deny your claim for other reasons, such as:

You are not listed as a beneficiary on the policy.
The accidental death insurance policy was not in effect at the time of the policyholder’s death.
The policyholder failed to disclose a medical condition on their insurance application.

Even if the insurance company uses one of these excuses not to pay, you may still have options. Call the McKennon Law Group PC to find out what your legal options are. Call 949-504-5381 to schedule a free initial consultation.

How Can an Accidental Death Insurance Attorney Make Insurers Do the Right Thing?

Insurance companies often use bad faith tactics to issue improper denials of accidental death and dismemberment claims. These acts may include the following:

Allege that the application contains a material misstatement and cancel or rescind the policy.
Impose a requirement for eligibility that was not clearly delineated in the policy or interpret an ambiguous term in its favor.
Deny coverage on the basis that the policy has lapsed.
Assert that the sickness or injury at issue was not caused by an accident.

When it comes to the question of whether there was an accidental injury, the law is very complicated. You will need an experienced accidental death insurance attorney to assist you with this type of denial. If an insurer is planning to lapse a policy, it must notify the policyholder (and a designee, if specified) of the upcoming lapse and offer a grace period. If the insurer fails to provide adequate notice, the lapse may be improper, and a denial issued on this basis may be overturned. An insurance company that improperly denies claims on accidental death and dismemberment policies may be acting in bad faith, and we are here to make sure they uphold their end of the contract.

If the Accidental Death and Dismemberment insurance policy was purchased directly from the insurance company without employer involvement, you might be entitled to recover not only the Accidental Death and Dismemberment insurance proceeds but also insurance bad faith damages, including emotional distress damages, consequential damages, attorneys’ fees, pre-judgment interest and punitive damages under California or other states’ law. If the policy was obtained through an employer, the dispute is most likely governed by the Employee Retirement Income Security Act of 1974, known as ERISA, and the insured can sue for policy benefits, attorneys’ fees, and interest due on the unpaid benefits.

How Does ERISA Affect Accidental Death and Dismemberment Claims?

Most insurance policies purchased through an employer are preempted by ERISA. That means that ERISA laws, rather than state contract or bad faith laws, provide the rights and remedies available to the policyholder and beneficiaries.

ERISA laws impose strict deadlines and limited remedies when it comes to filing an appeal after the claim denial. Missing a deadline can be enough to lose your right to challenge the decision in court. ERISA claims are limited in their remedies. Where California-governed insurance disputes allow the complainant to seek punitive damages, such as pain and suffering, ERISA claims do not. At most, you will be able to recover the benefits you were denied, certain legal fees, and possibly interest owed on unpaid benefits. This means certain less-than-honest insurance companies can deny claims, with the only punishment being that they have to pay the original claim they denied.

ERISA claims also require you to exhaust the insurance company’s internal appeals process before you file a lawsuit. This can be incredibly frustrating as it may feel like you are at the whim of the insurance company.

If the decedent’s insurance policy was purchased through their employer, you will likely have to deal with the ERISA process, something that is mentally and physically draining unless you have an experienced attorney.

What Role Does an Accidental Death and Dismemberment Insurance Attorney Play in the Appeals Process?

It is easy to feel defeated when your accidental death insurance claim is denied. In California, the appeals process is often the most critical stage of your case. Our attorneys will help you through the appeals process by guiding you through the following steps.

1. Analyze Your Denial Letter With You

The first step is dissecting the denial letter you received from the insurance company line by line. Our law firm will ensure that their reasoning is legally sound. We will also ensure that the insurance company follows proper ERISA claim procedures. If the insurance company is acting in bad faith, we will find out why.

2. Gathering Evidence

ERISA law limits the type and timing of the evidence that can be presented during your claim appeal. Whether your claim denial is governed by ERISA law or California law, our experienced attorneys will gather the crucial evidence that ensures the insurance company pays what it owes to you.

3. Directly Challenge Policy Exclusions

Insurance companies hide behind their exclusions to justify not paying claims. They are beholden to their shareholders, not their clients. We will examine exactly what information they are basing their denial on. If their argument doesn’t hold water, we will be sure to sink it in court.

4. Expose Procedural Errors

We will be sure to point out when the insurer violates any part of the ERISA law. They are also required to follow specific deadlines, and if they miss one, it can be enough to change the outcome of the appeals process. They also must provide detailed explanations when they deny claims. Insurance companies must also provide access to your claim documents, and we will make sure to inform the court when they fail to do so.

5. Frame Your Appeal With Exceptional Legal Precision

The appeals process requires you to craft a persuasive, legally sound narrative. Our experienced attorneys will write a legally informed and sound appeal letter to challenge the denial based on the facts.

6. Preparing for Litigation

Any attorney can write a half-okay appeals letter, but our law firm is not afraid of standing with you through the entire appeals process, including litigation, when necessary. Whether filing in federal court under ERISA or in state court for other insurance policy appeals, our experienced team is ready to stand in the face of shady insurance companies and ensure they uphold their end of the agreement.

Every step of the appeals process is easier when you have an experienced attorney by your side, ensuring you are meeting all deadlines, properly filing your documents, and guiding you through the legal process. McKennon Law Group PC offers a free initial consultation where you can learn if you have a strong appeals case.

What Shady Tactics Should You Look Out For?

When an insurance company denies a policy, it relies on a handful of factors to protect its shareholders’ bottom line. The company knows you are going through an incredibly stressful time, and it tries to deny benefits based on your emotional state. They hope you will miss important deadlines so they can outright deny your claim, significantly limiting your legal options and even preventing you from pursuing benefits.

Insurance companies rely on uninformed beneficiaries who appeal with limited supporting evidence for their claim denial. During the appeals process, they load the administrative record with evidence favorable to their position, making the appeal even harder to win. After the policyholder’s death, their insurance company may hide behind strict ERISA rules, which limit your ability to present certain evidence and limit your remedies.

Do you know what insurance companies hate? A beneficiary with a strong legal team backing them.

Our law office will fight for your rights and hold the insurance company accountable. At McKenna Law Group PC, our mission is to fight for you. Call 949-504-5381 to schedule your free initial consultation today.

Can McKennon Law Group PC Help With Your Accident Claim Denial?

The attorneys at the McKennon Law Group PC are specialists in litigating and resolving bad faith and ERISA insurance claim disputes for individual and business policyholders. We have litigated and been consulted on thousands of ERISA, disability insurance, life insurance, accidental death and dismemberment insurance, health insurance, bad faith, and other insurance matters. Because of our aggressive advocacy and our regional and national reputation as a leading insurance litigation firm, we can achieve maximum settlements and judgments/verdicts at trial.

We can aggressively litigate your accidental death case to achieve maximum success. We have significant trial experience and are not afraid to go to trial against the big insurance companies, we have extensive experience fighting them.

How Can You Get Started?

Helping policyholders and their beneficiaries secure their insurance claim benefits is what we do best. If you have been denied a claim related to accidental death and dismemberment, McKennon Law Group PC in California, will provide the aggressive representation you want and need. We offer free initial consultations, so please fill out this or call 1-800-682-4137.