Our life insurance law firm is happy to announce a resolved Fidelity Life insurance claim denial. Accidental Death and Dismemberment (AD&D) insurance provides coverage for death or serious injuries resulting from accidents. However, despite the straightforward nature of AD&D coverage, claims can still be denied for various reasons. One common reason for denial is the exclusion of specific causes of death or injuries outlined in the policy. Insurers typically exclude deaths resulting from non-accidental causes such as illness, suicide, or natural causes. If the insured's death is determined to be caused by an excluded event, the insurer may deny the AD&D claim, as it falls outside the scope of coverage.
Misrepresentation or non-disclosure of relevant information during the application process can also lead to claim denials. If the insured failed to disclose pre-existing medical conditions, hazardous activities, or lifestyle habits that increase the risk of accidents, the insurer may argue that the withheld information constitutes a breach of the duty of utmost good faith. Any discrepancies between the information provided in the application and the insured's actual circumstances can give the insurer grounds to deny the AD&D claim based on the misrepresentation or omission of material facts.
Moreover, certain policy limitations or exclusions may result in claim denials. For example, some AD&D policies have specific exclusions for injuries sustained while under the influence of alcohol or drugs. If the insured's death or injury is determined to be caused by intoxication, the insurer may deny the claim based on the exclusion. Similarly, injuries sustained during participation in excluded activities such as professional sports or illegal activities may lead to claim denials.
Another reason for denied AD&D claims is the failure to meet the policy's definition of an accident. While the definition of an accident may vary between policies, insurers generally require that the insured's death or injury be the direct result of an unforeseen and unintentional event. If the insurer determines that the death or injury was caused by a deliberate or foreseeable act, they may deny the claim on the grounds that it does not meet the definition of an accident.
Furthermore, disputes may arise regarding the cause of death or the extent of the insured's injuries. If there is ambiguity or conflicting evidence surrounding the circumstances of the accident, the insurer may conduct a thorough investigation to determine liability. If the insurer concludes that the death or injury was not accidental or that it occurred under circumstances excluded from coverage, they may deny the AD&D claim based on their findings.
Administrative errors or delays in filing the claim can also result in denials. If the insured's beneficiaries fail to submit the necessary documentation or meet the deadlines specified in the policy, the insurer may deny the claim due to non-compliance with claim procedures. Similarly, if there are discrepancies in the information provided in the claim forms or if the required evidence supporting the claim is incomplete or insufficient, the insurer may deny the claim until the discrepancies are resolved or additional evidence is provided. Therefore, it's essential for policyholders to thoroughly review their AD&D policies, disclose all relevant information accurately during the application process, and promptly follow the claim procedures in the event of an accident to avoid potential claim denials.
AD&D claims get denied frequently, but our life insurance lawyers are here to help.