A common employer-provided benefit is accidental death and dismemberment (AD&D) insurance. This is similar to life insurance in that the policy will pay out a sum of benefits in the event of an accidental death or an accident that costs someone their sight, hearing, speech or a limb. It can also cover paralysis.
Unfortunately, just like any other employer-provided insurance, insurance companies often find creative ways to dispute and deny claims. If you are grieving the loss of a loved one or your spouse is suffering from a serious injury, AD&D benefits are critical in dealing with the serious financial consequences of the accident.
Common reasons for claim denials
One of the most common reasons for a claim denial is the insurance company arguing that the death was no accident, or that it was the fault of the deceased. Common examples include:
- Calling the death a suicide, because the deceased accidentally overdoses on legally prescribed medication. This could also include someone who accidentally falls to their death.
- Blaming the victim’s recklessness for their death. This could be because of riding a motorcycle or engaging in a high-risk hobby, such as rock climbing. It could also include an insurance company arguing that the victim was speeding at the time of a fatal car accident, and thus acting negligently. Insurance companies also frequently use intoxication as a coverage exclusion.
- Blaming an illness or medical event for contributing to an accident. This could include a driver who got into a fatal accident after suffering a heart attack.
- Claiming that the death was not related to an accident because it took too long to occur after the accident. An example of this would be dying from complications from a serious accident more than a year later.
Why you need an attorney
The federal Employee Retirement Income Security Act (ERISA), an extremely complex law, governs work-provided AD&D plans. The insurance companies count on you not being aware of your rights or not having the right knowledge to successfully appeal a claim denial.
An attorney will know how to gather all of the right evidence and examine the language in the insurance policy to find the best strategy for filing an appeal. Do not try to handle an appeal yourself, especially when you are still dealing with the loss of a loved one. Allow an experienced attorney to handle this difficult work on your behalf and put you in much better position for a successful outcome.