The sudden loss of a loved one is a devastating experience, and it can feel even more overwhelming if the deceased was the primary breadwinner of your household. In such difficult times, many families rely on life insurance to cover financial obligations and ensure their well-being. If the deceased had purchased an Accidental Death and Dismemberment (AD&D) policy, the intention was to provide financial support in the event of an unexpected accident. Unfortunately, these claims are not always straightforward, and it’s not uncommon for beneficiaries to face denied AD&D life insurance claims.
An AD&D policy is designed to offer coverage in the event of an accidental death or serious injury, and it may be purchased as a supplement to a regular life insurance policy. Sometimes referred to as a "Double Indemnity" policy, it typically pays a larger benefit if the death results from an accident, rather than from an illness or health-related issue. However, the process of filing a claim and receiving payment can often be more complicated than expected.
What the Second “D” Means in AD&D
The second "D" in an AD&D policy stands for "Dismemberment," which provides coverage for injuries that result in the loss of limbs, vision, hearing, or other catastrophic impairments. If the insured person does not die but suffers severe injuries, such as the loss of one or more limbs, AD&D insurance can offer compensation to help the injured person cope financially, particularly if they can no longer support their family. It's essential to understand the specific terms of the policy, as the payout amount typically depends on the severity of the injuries.
Common covered injuries include the loss of a limb or the complete loss of one of the senses. If the insured person has suffered such injuries, it's critical to consult with an attorney if the claim is denied, as these claims are often contested by insurers.
Why Are Denied AD&D Life Insurance Claims So Common?
Denied AD&D life insurance claims are unfortunately not rare, even in situations where a standard life insurance policy may be paid out without issue. So, why do AD&D claims get denied? These policies come with specific criteria that must be met before a claim can be approved. Additionally, the exclusions in an AD&D policy are often more detailed and complex compared to a standard life insurance policy, which can lead to confusion and potential denials.
Some of the most common exclusions that insurers use to deny AD&D claims include:
Death by suicide: Most AD&D policies explicitly exclude coverage if the insured person dies by suicide.
Specific illnesses: Certain health conditions outlined in the policy may disqualify the claim.
Misuse of illegal substances or intoxication: Death or injury caused by drugs or alcohol is frequently excluded.
Unreported prescription medications: If the insured person was taking medication that wasn't disclosed when applying for coverage, the insurer may deny the claim.
Death resulting from criminal activity: If the insured person’s death occurred while committing a crime, the claim could be denied.
Failure to file a timely claim: Some policies require claims to be submitted within a specific time frame; failure to do so can result in denial.
Self-inflicted injuries: In cases where the insured person intentionally injured themselves to meet the "dismemberment" requirement, claims are likely to be denied.
Another common reason for a denied AD&D claim is the insurance company’s argument that an existing illness or health condition played a role in the death or injury. Many adults have some form of health issue, making it easier for insurance companies to claim that the cause of death was related to the illness rather than an accidental event. This is often used as an excuse to avoid paying out the claim. Additionally, alcohol consumption or the use of medications can complicate matters, though these do not automatically result in a denial. However, insurance providers may use these factors to argue that the death or injury was not purely accidental.
How an Attorney Can Help with Denied AD&D Claims
Dealing with a denied AD&D life insurance claim can be overwhelming, especially while grieving or caring for a loved one who has suffered a life-changing injury. This is where an experienced life insurance attorney can be an invaluable asset. A skilled lawyer specializing in AD&D claims can investigate the circumstances surrounding the death or injury, gather medical records, consult with experts, and build a solid case on behalf of the beneficiaries.
Insurance companies may attempt to deny claims for various reasons, but an attorney can hold them accountable. They are well-versed in the legalities surrounding life insurance policies and can help ensure that the insurance company adheres to its contractual obligations. If the insurer continues to reject the claim, your attorney can guide you through the legal process, which may involve filing a lawsuit or pursuing a settlement that ensures you receive the benefits owed to you.
We Don’t Get Paid Unless Your Claim is Successfully Paid
The thought of consulting a lawyer may seem intimidating, especially during such a challenging time, but the reality is that seeking legal help could significantly improve your chances of receiving the benefits you deserve. At our firm, we offer free initial consultations and work on a contingency basis, meaning we don’t get paid unless your AD&D claim is successfully paid out by the insurance company.
Our experienced attorneys are dedicated to helping clients with denied AD&D life insurance claims. We understand the stress and financial strain that comes with these disputes, and we are here to help you navigate the process with the goal of securing a positive outcome. Let us take this burden off your shoulders, so you can focus on what matters most: healing and recovery.