It is important to safeguard the financial future of your loved ones. To do this, many people rely on life insurance and accidental death and dismemberment insurance policies covered by the Employee Retirement Income Security Act of 1974 (ERISA) to provide for their families if they are killed or severely injured in an accident.
Unfortunately, many insurance companies choose to deny coverage to their policyholders for unfair or obscure reasons, making the lives of disabled individuals and survivors even more difficult. If you or your family experience ERISA accidental death and dismemberment insurance denials, a dedicated ERISA lawyer may be able to help you fight back.
Since accidental death and dismemberment—AD&D for short—policies only provide payouts for certain types of deaths and accidents, insurance companies closely examine how a person was killed or injured before making a denial. If they suspect the person died of natural causes, they would more than likely deny the claim.
Many insurance companies become suspicious when a person claims a death or injury is accidental, even those governed by ERISA. In reality, accidents like car crashes, drowning, equipment failures, and even slips and falls claim millions of lives across the country each year. AD&D policies also provide coverage for individuals who lose a limb in an accident, as well as those who lose their hearing and sight.
Often, ERISA-governed insurance companies attempt to deny a claim based on a preexisting medical condition. This is acceptable in some cases since the law does allow insurers to deny certain types of coverage to individuals with existing medical conditions. However, some insurance companies attempt to do this even when they cannot prove the death of a policyholder is linked to such a condition.
Insurance companies often hire their own physicians and other medical professionals, and they may consult these individuals before denying or approving a claim. The input from these medical professionals is usually biased, though, primarily because they are employed by the insurance company and they rarely have access to all the available medical information. A lawyer specializing in ERISA accidental death and dismemberment insurance denials could reach out to additional medical professionals to dispute the claims of the insurance company.
When a person or their beneficiary attempts to file an AD&D claim, the insurance company may deny coverage if they believe the person was not harmed or killed in an accident. The law allows insurance companies to deny AD&D benefits to individuals who take their own lives or die from drug overdoses. They may also deny benefits if they believe reckless or dangerous behavior led to the death of a policyholder.
While it is technically legal, it can also be immensely distressing to the family of the deceased policyholder. However, it is possible to fight back against such claims by presenting relevant evidence and finding holes in the insurance company’s argument. For this reason, it is important for beneficiaries and policyholders not to give up after a denial of ERISA accidental death and dismemberment insurance when they may have legal options at their disposal.
Beneficiaries and policyholders should remember that a denial from the insurance company is not always set in stone. With the right attorney on your side, you may be able to fight back against the insurance company and obtain the benefits you and your family need to maintain your standard of living. Learn more about ERISA accidental death and dismemberment insurance denials by calling a dedicated ERISA lawyer today.
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