There are no guarantees in life. You can be doing fine one day and be involved in a fatal accident the next day. Even if you have a life insurance policy for your beneficiaries, you may want a rider on your policy to provide additional compensation for your loved ones.
For life insurance policies, one critical policy that fits this description is an accidental death and dismemberment policy. When your beneficiaries file an accidental death claim through your policy, they should receive their benefits with little to no issue.
Unfortunately, insurance companies deny legitimate accidental death or dismemberment claims for various reasons. When your accidental death claim gets rejected, you have the right to challenge the insurance company's decision through an appeal. While you are grieving over the loss of your loved one, seeking the legal counsel of a Baton Rouge accidental death and dismemberment lawyer from the J. Price McNamara ERISA Insurance Claim Attorney can benefit you and your family in many ways.
Never feel like you must handle your claim alone, and never try to appeal a claim denial without the right legal guidance and representation. Consult with our legal team and learn how we help our clients today.
Table of Contents
- What are accidental death and dismemberment insurance?
- What doesn’t accidental death and dismemberment cover?
- What do accidental death and dismemberment policies cover?
- How accidental death and dismemberment insurance is purchased
- How our Baton Rouge accidental death and dismemberment lawyer can help you
- Talk to a Baton Rouge accidental death and dismemberment lawyer today
What are accidental death and dismemberment insurance?
Accidental death and dismemberment insurance is an insurance policy that offers coverage to the beneficiaries of a policyholder who was killed or injured in an accident. This insurance policy is unique because it only provides coverage to people injured due to accidents. Another unique aspect of accidental death and dismemberment policies is that they provide coverage for fatal accidents and accidents that result in dismemberment.
Each insurance policy is different. The general rule is that a policyholder and their beneficiaries cannot receive benefits unless the policyholder's disability or death occurs because of an accident. When you have questions about accidental death and dismemberment insurance, speak to a Baton Rouge lawyer today.
What doesn’t accidental death and dismemberment cover?
Accidental death and dismemberment insurance can only cover accidents. If a policyholder's death resulted from a natural cause or self-harm, neither the policyholder nor their beneficiaries will receive benefits.
Accidental death and dismemberment policies often cover fatal accidents at home, work, or on the go. Some accidental death and dismemberment policies offer their policyholders double or triple the compensation if the accident occurred while traveling on public transportation.
What do accidental death and dismemberment policies cover?
Depending on the type of accidental death and dismemberment policy purchased, your policy can offer compensation ranging from 50 percent to 100 percent of your benefits based on the nature of your injury. For example, if you become paralyzed after being involved in a motor vehicle accident, you can potentially receive at least 100 percent of your benefits.
If you suffered an amputation after your motor vehicle accident, you can receive financial compensation for up to 50 percent of your financial coverage. Because you can add accidental death and dismemberment policies as a rider in a life insurance policy, the compensation you can receive is equal to your life insurance policy.
How accidental death and dismemberment insurance is purchased
In addition to adding accidental death and dismemberment as a rider in your life insurance policy, there are several ways that you can purchase this type of insurance.
You can buy it through work if your employer offers it in the company’s employee benefits package. You also have the option of purchasing individual coverage or group coverage. With individual coverage, you can purchase through private insurance companies and customize your insurance policy. If you purchase group coverage, ERISA will cover your insurance policy.
Benefits of accidental death and dismemberment insurance
When an accident kills or dismembers a policyholder, AD&D insurance can provide financial coverage. Depending on the circumstances of your accident, your family is entitled to additional compensation based on your policy. For example, suppose you were in a motor vehicle accident and were wearing your seat belt at the time. In that case, some insurance policies will offer you additional compensation if that accident led to your dismemberment or death. Some insurance policies will also provide your beneficiaries other benefits that they can benefit from, such as counseling or legal services.
Additional benefits that come with accidental death and dismemberment insurance
Other benefits that come with accidental death and dismemberment insurance include the ability to receive coverage quickly. Policyholders and their beneficiaries need not be concerned with filling out questionnaires or taking any medical exams to receive benefits. All you or your beneficiaries must do is file an accidental death claim and wait for the insurance company to approve your claim within days.
Accidental death and dismemberment insurance policies can benefit people with pre-existing conditions. People with pre-existing conditions who have difficulty looking for affordable life insurance can take advantage of this insurance policy.
How do you and your beneficiaries receive your accidental death and dismemberment benefits?
If you die from a fatal accident, the beneficiaries you name on your policy will receive a lump sum payment from the insurance company. If an accident left you dismembered, you might receive living benefits based on the type of injury that you sustained. If you purchase your accidental death and dismemberment insurance from your employer, the employer or insurance company will set the level of coverage you can get.
Understanding the terms of your policy
Before filing your accidental death claim with the insurance company, you must review the terms and conditions of your policy. You can ask for a copy of your insurance policy’s plan document. In the plan document, you can find the summary plan description, which will include critical information like your claim, appeal procedures, and eligibility for benefits. The summary plan description also explains the exceptions to the policy. Becoming more knowledgeable about your policy can bring additional clarity when filing your claim.
Dealing with an accidental death claim denial
Accidental death and dismemberment claims can be confusing to navigate. This confusion is partly because insurance companies include technical jargon and loopholes that they can use to deny a claim in the policies themselves. Many accidental death and dismemberment claims get denied for several reasons.
Some of the common reasons include:
- Blaming the policyholder’s dismemberment or death from a pre-existing condition
- Listing medical treatment as the cause of a policyholder’s disability or death
- Seeking compensation for a death that did not happen within the specific period
- Seeking compensation for an accident excluded from the insurance policy
- Insinuating that the policyholder’s dismemberment or death was a result of substance abuse
- Seeking compensation for a fatal accident that was unwitnessed
Filing an appeal for your accidental death and dismemberment claim
As we stated before, if you purchased your employer's accidental death and dismemberment policy, ERISA covers your insurance policy.
Because ERISA is a federal law that protects employees' retirement and benefit plans, there are strict guidelines that you must follow when filing an appeal. One of those strict guidelines includes following the administrative appeal process of the insurance company. You must exhaust all administrative appeals with the insurance company before you can file a federal lawsuit.
ERISA laws and their impact on your accidental death claim process
Filing an appeal with an ERISA-covered accidental death and dismemberment insurance policy is more complicated than appealing a private accidental death and dismemberment insurance denial. The procedures and deadlines are stricter and leave no room for error on your part.
If you miss the deadline to file an appeal with the insurance company, you can lose out on your ability to file a federal lawsuit against the insurance company in the future. The only way that you can even get permission to file a lawsuit is by wearing out all of your administrative appeals with the insurance company.
Your administrative record
One of the most critical elements of your appeals process is your administrative record. Your administrative record is the file that an unbiased evaluator and federal judge (should you choose to file a lawsuit) will examine to prove whether your claim deserves to be denied or overturned. Any information not included in your administrative record essentially does not exist. Many applicants set themselves up for another denial by failing to provide the best evidence in the administrative record.
How our Baton Rouge accidental death and dismemberment lawyer can help you
When you are the victim of a fatal accident, you and your beneficiaries deserve to receive compensation for your accident without being pulled and prodded along by insurance companies. Your accidental death claim should not get denied because insurance companies do not want to provide you with just compensation.
At J. Price McNamara ERISA Insurance Claim Attorney, our Baton Rouge accidental death and dismemberment lawyer are familiar with insurance companies' tactics to avoid paying your accidental death claim.
Because the ERISA laws make appeals more difficult for policyholders and cater to the insurance company’s rights, adjusters want to use that to their advantage. Insurance companies hope you give in to their ridiculous demands and reconsider filing for an appeal. An experienced accidental death and dismemberment lawyer in your corner can decide whether your claim can be approved or not.
Make the ERISA process easier to navigate
An experienced accidental death and dismemberment lawyer knows the ERISA laws and the procedures to file an appeal. An accidental death and dismemberment lawyer can explain the laws in more depth to you and offer legal advice that can strengthen your chances of success in your appeals process. There is a sense of clarity and relief knowing that someone skilled in the appeals process is navigating you through the process. You can be more confident throughout the process, knowing that a qualified accidental death and dismemberment lawyer is leading them on the right course.
Present the best administrative record for your case
Because your administrative record is the most critical piece of your appeals process, you want to ensure that you have the most robust administrative record possible to present to the evaluator. Even though you can collect records like your medical records and tests, an experienced accidental death and dismemberment lawyer has access to other pieces of evidence that can strengthen your administrative record.
While the insurance company can argue a lack of crucial evidence associated with your accidental death claim, your accidental death and dismemberment lawyer can provide the vital evidence needed to overturn the insurance company’s decision.
Poke holes in the insurance company’s argument
If you seek the aid of an experienced accidental death and dismemberment lawyer, you have a valuable resource who can serve as an adversary against the insurance companies. Insurance companies are known for taking advantage of their policyholders and only doing right when you involve an attorney.
An experienced accidental death and dismemberment lawyer can analyze an insurance company’s denial letter and prove through your administrative record how weak the insurance company’s reasoning is for your denial. Your accidental death and dismemberment lawyer can analyze your insurance policy and explain how the insurance company reacted too quickly by issuing a denial of your claim.
Talk to a Baton Rouge accidental death and dismemberment lawyer today
At J. Price McNamara ERISA Insurance Claim Attorney, our accidental death and dismemberment lawyer wants to help you and your family recover the benefits you deserve. We will help ensure that the insurance company does right by you and your family and use the appeals process to your advantage when they do not.
Call our firm today at (225) 201-8311 or complete our contact form for your Free Denial Review. You deserve compensation when your loved one has suffered a dismemberment accident or died in a fatal accident.
Let our team fight for your right to compensation, so you are not paying out of your own pocket for medical and other expenses.
Baton Rouge Office
10455 Jefferson Hwy,
Suite 2B
Baton Rouge, LA 70809
Phone: 225-425-7917
Fax: (225) 201-8313
(By Appointment)
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