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Denied Accidental Death and Dismemberment Claims

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Dos & Don’ts

Denied Accidental Death and Dismemberment Claims

  • Do realize that the insurance company dislikes paying accidental death claims.
  • Do immediately gather all insurance policy documents.
  • Do get the medical examiner’s report.
  • Do, if alcohol played a role, get an independent alcohol test completed ASAP.
  • Don’t get contact information for all witnesses.
  • Don’ presume that because the death certificate lists the manner of death as “accidental” that the insurance company will pay.
  • Don’t provide any information to the insurance company before consulting an attorney.
  • Don’t be afraid to hire your own pathologist to conduct a private autopsy
  • Don’t go it alone – talk to a pro.

Insurance Claims Attorney on Denied Accidental Death and Dismemberment Claims

Accidental Death and dismemberment

People often purchase accidental death and dismemberment policies to fill in the gaps in coverage in their life insurance policies. Accidental death and dismemberment policies pay out a lump sum benefit to beneficiaries after a covered loss. However, every year many accidental death and dismemberment claims are unfairly denied by the insurance company. Should your claim be denied, contact an experienced Insurance claims attorney for help with your appeal.

Common Reasons Why Accidental Death and Dismemberment Claims Are Denied

Two of the most common reasons why claims for accidental death and dismemberment insurance are denied are:

The death or dismemberment was not the result of an accident.

These policies pay only when the loss was caused by an “accident.” You might think it should be easy to establish the occurrence of an accident. But sometimes this is a gray area.

For example, suppose the insured suffered a non-fatal medical emergency (such as a seizure or heart attack), while driving. The medical emergency caused the insured to crash and the crash caused the death. Or suppose a person with a medical condition that predisposes him to blood clots when flying takes a long distance flight. He develops a blood clot that travels to his lungs and proves fatal. He wouldn’t have experienced the blood clot if he didn’t have the medical condition, but he also wouldn’t have experienced the clot if he hadn’t flown.

Insurers often deny claims in situations like this on the grounds that the actual cause of death was the medical problem.

The death or dismemberment was within a policy exclusion.

Exclusions are exceptions that are not covered by the policy. Deaths caused by driving while intoxicated and deaths caused by drug overdose are two typical exclusions in AD&D policies. Suppose the insured was driving while intoxicated, but the accident that killed her was entirely the other driver’s fault. The intoxication played no role. Or suppose the insured was killed by an accidental overdose of a prescription medication.

Depending on the language of your policy, the governing law, and the availability of evidence proving what actually happened, situations like these may well be worth fighting. Insurance claims attorney Jonathan M. Feigenbaum understands the language of insurance policies, as well as how to successfully file for benefits under ERISA and non-ERISA policies. He can review your policy language in light of the applicable law and evaluate your right to benefits.

Other reasons for denied claims

  • Denying the claim because the accident didn’t “directly cause” the death or dismemberment or because the death or dismemberment occurred too long after the accident.
  • Denying the claim because of unpaid premiums.
  • In the case of employer provided AD&D insurance, denying the claim because the employee hadn’t met the requirements for coverage (e.g., not employed for long enough or not working enough hours).

Your Right to an Appeal – Contact a Boston Insurance Claims Attorney Today

You have the right to appeal your insurance claim denial. But you have a limited time to file your request for an appeal. Most appeal deadlines are 90 days from the time of the denial. Don’t delay and don’t try to represent yourself. The issues are technical and require the expertise of an attorney. Call Jonathan M. Feigenbaum, Esquire, for assistance before the time runs out. Reach him at 617-357-9700 or toll free at 866-396-9722.


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