You have probably seen the advertisements on television but still ask yourself “What is accidental death and dismemberment insurance?” This type of insurance provides individuals with additional protection than a basic life insurance policy as it extends coverage should a death be determined accidental. These are often added to a life insurance policy so that if a policy holder dies accidentally, their heirs receive a much larger payout. If the policy holder loses a limb but does not die, they receive a payment based on coverage outlined in the policy.
Claim Denial
Unfortunately, some insurance companies will attempt to avoid paying accidental and dismemberment claims. They may attempt to prove that the death was not accidental or that the insured contributed to their own death or injury because they were intoxicated or under the influence of drugs, including those prescribed by a doctor.
Material Misrepresentation
The insurance company may claim that the insured misrepresented themselves on the application if it is discovered they were under the influence of drugs. Most applications for accidental death and dismemberment insurance ask the policyholder to list any medications they were taking at the time of the application. Patients rarely inform life insurance companies when their prescriptions change, but the insurance company can claim that failing to include a prescription drug, even one prescribed after the application was submitted, constitutes material misrepresentation of facts, denying payment on the claim.
Not Accidental
If there is a chance that use of prescription drugs led to the death of the insured, an insurance company may deny the claim. For example, if an insured took a prescription drug that made them drowsy and then died in a car accident because they fell asleep, the insurance company may attempt to deny payment for accidental death. In order to fight this denial, you may be required to prove that the person who was insured did not expect or intend to die after taking the prescription and that it was simply a mistake. In addition, the insurance company must show irrefutable evidence that the prescription drug was the main cause of the accident that caused the death.
Standing Up to an Insurance Company
It is possible to fight an insurance company who denies a claim for accidental death when the person who died held an accidental death and dismemberment policy. It may require witness accounts of the person’s use of prescription drugs, toxicology analysis and testimony from treating physicians who can refute claims that the prescription drug caused the person’s death. In addition, documentation that a drug was prescribed after the application for coverage was submitted or using ambiguity in the policy itself can be used as a defense against a delayed or denied claim for accidental death.
What Is Accidental Death and Dismemberment Insurance?
Once you are aware what accidental death and dismemberment insurance is, you are better able to deal with an insurance company who is attempting to deny a claim. If you or a loved one is dealing with a denied claim for accidental death or dismemberment, contact Jonathan M. Feigenbaum at 617-357-9700 to learn what rights you may have regarding your claim. You don’t have to fight the insurance companies alone as the knowledgeable attorneys have worked with people just like you to get their claims resolved as quickly as possible. Not only does Jonathan M. Feigenbaum know what is accidental death and dismemberment insurance, they have experience in fighting claim denials related to prescription drug use and intoxication.
