Policyholders and beneficiaries don’t always understand the difference between life insurance and accidental death and dismemberment insurance. When a claim is denied, they are confused about the reasons and what to do next. Insurance policies can be long, complicated, and filled with ambiguous language and fine print.
If your claim for life insurance or accidental death and dismemberment benefits has been denied, speak with Life Insurance claim lawyer Jonathan M. Feigenbaum, Esquire. He will review your policy, explain the benefits to which you are entitled, and advise you of the next steps to contest the insurance company’s decision.
Life Insurance. Life insurance policies provide a lump sum benefit when the insured individual dies. The death can be the result of age, illness, an accident, or a crime. Even death by suicide will be covered if the policy has been in force for several years.
Accidental Death and Dismemberment (AD&D) Insurance. This type of policy provides limited coverage for certain accident-related deaths, and loss of limbs, sight, or hearing, but not death through illness or disease not caused by an “accident.” Because this coverage is limited to accidental death, it is the cheapest life insurance coverage you can buy and usually does not require detailed application questions or a physical exam.
Some life insurance policies contain an accidental death provision that pays an extra benefit if the insured dies in an accident. The extra benefit is often equal to the regular death benefit, thus doubling the payout. These provisions are sometimes referred to as “double indemnity.”
Exclusions are situations listed in the policy that the policy does not cover.
Life Insurance. Typically, life insurance policies exclude from coverage death by suicide within two (or sometimes three) years after buying the policy. Some life insurance policies provide additional exclusions for death during war, the commission of a felony, or certain hazardous occupations or activities. Instead of a hazardous activities exclusion, some life insurance companies ask applicants to disclose their hazardous activities (e.g., smoking, sky diving, etc.). They then decide whether to issue the insurance and whether to adjust their premiums upwards to take into account the increased risk. If the policy is issued, a death caused by the hazardous activity will be covered.
Accidental Death & Dismemberment Insurance. Typical policy exclusions for accidental death policies include deaths due to sickness, suicide or self-inflicted injury, drug overdose, driving while intoxicated, war, surgery, and enumerated high risk activities.
Both life insurance and accidental death and dismemberment insurance policies can be purchased independently from an insurer or provided as an employee benefit. When offered through a private sector employer or union, the policy will be governed by the Employee Retirement and Income Security Act (ERISA), a federal law. ERISA is a complicated law that was enacted to protect employees, but that has been interpreted to favor insurance companies.
When your policy is governed by ERISA, you have no right to a jury trial if a lawsuit is necessary. The judge will make a decision by reviewing the evidence you already sent to the insurance company during your application and appeal. If you win, you will get the benefits you are owed, and perhaps attorneys’ fees, but no additional damages. When you have an ERISA policy, you need an attorney with in-depth knowledge of its intricacies. Mr. Feigenbaum is a highly experienced and successful ERISA attorney having devoted a good portion of his career to obtaining benefits for clients from ERISA policies.
When purchased individually or obtained through a government or religious employer, life insurance and accidental death and dismemberment insurance will be governed by state contract law. With a non-ERISA policy, you can demand a jury trial. In addition to the benefits you are owed, you may be entitled to compensation for your emotional distress and other losses you suffered if the insurance company denied your claim unfairly and in bad faith.
Contact an Insurance Claim Attorney
Whether you purchased your life insurance or AD&D policy outside of work or it was provided as an employee benefit, contact Insurance Claim attorney Jonathan M. Feigenbaum, Esquire for skilled representation in appealing a denied claim. From aggressive negotiation to benefits litigation in court, we are here to protect your rights to the insurance coverage you paid for.
Serving individuals in Massachusetts, Connecticut, Rhode Island & New Hampshire.