What Are Your Family’s Rights When a Loved One Dies in an Accident?

Insurance companies define accidental death as a fatality that happens strictly as the result of an accident. If a family member dies and the insurance company rejects your accidental death claim, you are going to need the legal advice and services of a California accidental death attorney.

An accidental death benefit is a payment owed to the beneficiary of a life insurance policy with accidental death coverage – coverage that is usually spelled out in a rider attached to the policy. Accidental death benefits are optional, so they’re not included in a standard life insurance policy.

Here is how accidental death benefits work. If you have a $500,000 life insurance policy with a $1 million accidental death benefit rider, and you die of a stroke or a heart attack – a “natural” death – the payout to your beneficiary is $500,000. But, because the death was not from an accidental bodily injury so the insurer will not pay out the $1 million in accidental death benefits.

Why Are Accidental Death Benefits So Important?

If you or a family die in a car accident or a fall, your beneficiary will receive the $500,000 life insurance payout along with the $1 million accidental death benefit for a total of $1.5 million.

Accidental death benefit riders are often added to life insurance policies to protect family members should accidental death occur. Accidental death benefits can help families who might otherwise face a financial hardship when an unexpected death occurs.

Accidental death benefits are particularly important for those in hazardous lines of work like construction and law enforcement. Even people who drive for a living – taxi drivers and commercial truck drivers, for example – should probably consider accidental death benefit riders.

Narrow Terms for Accidental Death Coverage

Accidental death benefit riders usually exclude not only “natural” deaths but also acts of war and deaths caused by a policyholder’s criminal activities. Any dangerous hobby that the policyholder regularly practices, like bungee jumping or race-car driving, will also be excluded.

The narrow terms of coverage make accidental death benefit riders affordable, but those narrow coverage terms also give an insurance company more ways to deny your claim.

Has Your Accidental Death Benefits Claim Been Denied?

Some accidental death benefit riders may also cover dismemberment, amputation, burns, paralysis, and similar injuries. These riders provide what is called accidental death and dismemberment (AD&D) coverage.

If an insurance company denies your AD&D claim after a loved one’s accidental death, you may have to take legal action against the company to recover your benefits, and you will need the advice and services of the right California accidental death lawyer.

Insurance companies do not want to go to court. Instead, an insurance company may delay your claim, reject your claim, or ignore your claim entirely and hope that you will just give up. When an insurance company crosses the line and violates your rights, the company could be guilty of bad faith.

What is Insurance Bad Faith?

Consumers pay substantially for insurance, so an insurance company’s bad faith denial unacceptable. “Bad faith” is the legal phrase for what happens when an insurance company handles a claim unreasonably or denies a claim without good cause for doing so. Bad faith insurance practices include but are not limited to:

1. continuing attempts to pay you less than your claim is worth
2. Unreasonable delays in processing your claim
3. offering disingenuous or obviously inappropriate reasons for the denial of your claim
4. implying that your own coverage may be cancelled if you do not take a settlement offer
5. stalling by constantly asking you for more information that is not relevant to the claim

The rejection of an AD&D claim is not necessarily bad faith. A bad faith claim must arise from the insurance company’s particular actions or failures to act.

What Are Your Rights in a Bad Faith Insurance Case?

Sometimes, merely retaining the services of a California insurance claims attorney is enough to compel an insurance company to make good on its responsibility to you. A letter from your lawyer might be all that it takes.

Even so, you should be represented by an attorney who has considerable experience handling bad faith insurance cases. If the AD&D coverage was purchased directly from an insurance company and was not part of an employer-sponsored group plan, you may be able to recover:

benefits payable under your AD&D policy
economic damages
emotional distress damages
punitive damages
attorneys’ fees and more

But if the AD&D coverage was obtained through an employer-sponsored group plan, a dispute will probably be governed by the Employee Retirement Income Security Act (ERISA), and you may recover only the AD&D payout, attorneys’ fees, and interest due on the unpaid benefits.

How Are Insurance Claims Cases Handled?

If the coverage was purchased directly from an insurance company, a California civil court will have jurisdiction if you bring a bad faith insurance lawsuit.

If the coverage was obtained through an employer-sponsored plan, you must file an administrative appeal before you can bring a lawsuit. If your appeal is unsuccessful, your lawsuit will be filed in a U.S. District Court. Federal courts have jurisdiction in all ERISA-related cases.

If your AD&D claim goes to an administrative appeal or to a state or federal court, the right California accidental death attorney will advocate aggressively and effectively on your behalf to recover the compensation that is rightfully yours.

Why Would an AD&D Claim Be Denied?

An insurance company might deny your AD&D claim by asserting that there is insufficient evidence (or no evidence at all) that the death was accidental. Your attorney will examine the evidence, speak with any witnesses, and get to the truth regarding your loved one’s death.

An insurance company might also claim that one or more payments were missed or that you missed a filing deadline. Your attorney will scrutinize all of the pertinent records and documents to prepare the strongest possible case on your behalf.

How Will an Insurance Claims Attorney Help You?

In an administrative appeal or an insurance bad faith civil trial, your attorney will present the evidence that your loved one’s death was in fact accidental. Choosing the right attorney – a California attorney with significant insurance claims experience – can make all the difference.

The right attorney knows all of the insurance companies’ tactics and knows how to fight back. Your attorney will know if the company is dealing with you straightforwardly or in bad faith. Most importantly, your attorney will help you recover the insurance payout you are owed.

Losing a loved one is an emotionally difficult experience, and no amount of cash can replace that person in your life. Nevertheless, if your accidental death and dismemberment insurance claim is denied, you’ll need to reach out as quickly as possible to a California insurance claims attorney.