Purchasing an Accidental Death and Dismemberment (AD&D) insurance policy is easy, but receiving the benefits when a loved one dies in an accident may be difficult. Big insurance companies often deny payment for AD&D insurance settlements. These settlements are usually quite hefty, so insurance companies do what they can to prevent payouts from happening, even if that means denying a case.
Suppose an insurer denied you or your loved one’s insurance benefits after losing a family member to an accident. In that case, it is wise to seek legal counsel from a Louisiana insurance dispute lawyer for accidental death and dismemberment right away. An experienced AD&D lawyer will handle the claim process and strive to win your rightful benefits.
The law firm of J. Price McNamara ERISA Insurance Claim Attorney stands up for the rights of policyholders to get proper insurance benefits. We handle initial claims and appeal claim denials. Reach out today to learn how we can help you.
Table of Contents
- AD&D Insurance Is an Add-On
- Filing an Accidental Death Claim
- Why Do Insurance Companies Deny Claims?
- AD&D Claim Denials
- The Administrative Appeal
AD&D Insurance Is an Add-On
AD&D policies are usually add-ons to a regular life insurance policy. It is an inexpensive rider that most people purchase as an afterthought. Employers often provide AD&D insurance at low rates or as a benefit for their employees. An insured’s beneficiaries, usually a surviving spouse, a child, or a parent, are entitled to a lump-sum payment if the policyholder dies in an accident.
Those dismembered by accident will receive living benefits if an accident causes dismemberment. This insurance policy will also pay benefits when an insured loses a bodily function like eyesight or hearing; or if an insured loses a limb or uses limbs due to an accident.
The Employee Retirement Income Security Act of 1974 (ERISA) oversees employer-provided insurance benefits.
ERISA provides minimum standards for private businesses’ voluntary health and retirement plans to protect the individuals enrolled in these plans. It may be necessary and beneficial to acquire legal help due to the distinct, unique, and complex nature of AD&D insurance. It is important to receive legal advice before filing your initial accidental death or dismemberment claim. An experienced insurance attorney familiar with ERISA can ensure you properly complete your AD&D claim. At J. Price McNamara ERISA Insurance Claim Attorney, we can provide a secure start for your claim process.
Accidental death and dismemberment add-on policies are “double indemnity” riders. Double indemnity refers to double payouts. When an insured dies because of an accident, the beneficiaries are entitled to life insurance policy benefits and accidental death policy benefits. This amounts to double payments.
Benefits include the original life insurance policy’s face value times two. Dismemberment benefits tend to be less. A percentage of the original life insurance policy’s face value gets paid out when an insured individual suffers an amputation, loses eyesight, hearing, or speech, becomes paralyzed, or loses the use of limbs or body parts due to an accident.
Key facts to remember about AD&D insurance policies include:
- AD&D insurance is an addition to a life insurance policy. It is often an option in an employee’s benefits package.
- If a policyholder dies or becomes dismembered because of an accident, AD&D insurance benefits should go to the beneficiaries or the dismembered policyholder.
- Limitations and exceptions always apply to AD&D insurance policies. Review your policy, so you know its limitations.
- Only accidental deaths have AD&D insurance coverage. Dying from natural causes is not covered.
- Survivors can receive twice the amount of the insured’s life insurance policy. Payments include the original life insurance payout and the AD&D insurance payout. In a dismemberment situation, insured individuals will receive a percentage of the face amount of their regular life insurance policy, depending on the type and extent of their injuries.
Filing an Accidental Death Claim
If you are the beneficiary of your loved one’s insurance policy, you will be responsible for filing an accidental death claim if you want to receive benefits. You must provide proof of accidental death to the claims examiner or adjuster. You can provide witness statements, accident reports, medical records (both before and after the accident), prescription information (from before and after the accident), toxicology reports, coroner’s reports, autopsy reports, and a death certificate.
You may need to provide additional information and documentation upon request. The insurance company may delay or deny your claim if items or documentation are missing. If you provide all necessary items upfront, you will avoid problems with your claim. An insurance attorney will be helpful when fulfilling these requirements. Their assistance may prevent an insurance company from delaying or denying your benefits.
What to Do When You Receive a Claim Denial
Many AD&D claims do not initially succeed, even when premiums are up to date, and insured individuals and beneficiaries should have protection under ERISA. This particular type of claims process is confusing and difficult. Insurers might reject a claim for something as simple as a missing date or record. In one appeal, we obtained a $1.3 million trial verdict for an AD&D payout after a claim denial.
Seemingly minor mistakes often result in denials. If your claim gets denied, an experienced ERISA Accidental Death and Dismemberment insurance lawyer can assist you with all the intricate details of an AD&D claim.
AD&D benefits are often significant for accidental death claims. Double indemnity means double payouts. Insurance companies may delay or reject claims, so they do not have to pay the insured’s beneficiaries big money.
Big companies can easily manipulate grieving spouses and injured individuals. Insurance companies know this and will try to take advantage of the situation. They often use whatever means necessary to deny benefits. Insurance companies count on claimants’ lack of knowledge and motivation to fight for their benefits. An AD&D life insurance lawyer from J. Price McNamara ERISA Insurance Claim Attorney will fight the big companies and work to win you a fair settlement.
Why Do Insurance Companies Deny Claims?
Insurance companies don’t provide benefits for varied reasons. How each insurance company defines an accident can be subjective. Coverage limits depend on each insurance company, the specific policy, and even the state where the insured lives. Insurance companies will deny claims stating that the death was not accidental.
Some denial reasons cited by insurance companies include:
- The death was on purpose, or the insured committed suicide.
- Recklessness was the cause of death or dismemberment. Examples include reckless behaviors like mountain climbing or skydiving.
- The time between the accident and death was too long. The insured’s death did not immediately follow the accident. For example, a person in a car accident dies months later in the hospital.
- Death resulted from a non-covered medical issue like a heart attack or stroke. For example, a person suffers a heart attack while driving, and that causes an accident. The insurance company may assert that the death or dismemberment was not due to the accident.
- Alcohol or drug abuse that causes insurance companies may not cover an accident under an accidental death or dismemberment claim.
Losing a loved one is a difficult experience. The grief can overwhelm families. Negotiating an AD&D claim is often too much for someone grieving to handle. Insurance companies may not care about the survivors and their heartache. Insurance companies and legal teams may calculate their actions and do what is necessary to avoid paying big settlements to beneficiaries.
AD&D Claim Denials
Unfortunately, most AD&D claims receive an initial denial. If an insurance company denies your claim, you must file an administrative appeal to seek your rightful benefits. An administrative appeal involves a complex process, and you must complete it with care. A simple mistake can cost you everything. Seeking help from an experienced AD&D insurance lawyer from J. Price McNamara ERISA Insurance Claim Attorney will help ensure that you follow the process and do things correctly to receive your benefits.
The federal ERISA governs AD&D insurance claims, especially in which the policies are employer-provided plans and packages. The ERISA accidental insurance claim appeal process can be confusing and overwhelming. The insurance company and its lawyers know how to work the appeal process and are, but you may know how.
Hiring someone who focuses on accidental death and dismemberment claims will help you through this process. A reputable lawyer with extensive experience in AD&D claims and appeals will know how to plan accordingly, prepare relevant and convincing arguments, and help alleviate some of your worries about the case and your future.
Many survivors and beneficiaries file ERISA administrative appeals without the guidance of an attorney, and their claims are often unsuccessful. You only have one administrative appeal, which you must navigate carefully, or you can lose your chance for a proper settlement.
You must collect crucial evidence quickly. This evidence must establish your case, as it will be the only evidence allowed if your case goes to court. Any evidence presented during the appeal process will become the legal record of your claim. Additional evidence will not be allowed in future court proceedings. You can lose the chance to win your claim back if you are unprepared.
The Administrative Appeal
- A beneficiary files a claim for AD&D benefits and receives a written denial from the policyholder’s insurance company.
- You must complete an administrative appeal with the insurance company if ERISA governs your claim.
- You must file your appeal within 60 days of receiving the written denial. If you miss the deadline, the insurance company can dismiss the appeal, and you will not receive benefits.
- The insurance company has the final decision regarding the payment of AD&D benefits.
- Insurance companies usually deny appeals. If this happens, you have no option but to file a federal lawsuit against the insurance company.
ERISA lawsuits are filed in federal courts but do not follow federal protocols. They follow their own rules, which can be confusing for a claimant. It is a wise move to seek the advice of an experienced ERISA lawyer. They understand the distinct characteristics of ERISA litigation and will protect your rights and defend your interests.
An experienced ERISA lawyer will be comfortable with the intricacies of AD&D lawsuits and know how to proceed. That is why it is in your best interest to retain legal counsel. You cannot present new evidence in an ERISA case; the court can only review the evidence you previously provided during the administrative appeal. That’s why it is important to get things right during the administrative appeal.
The administrative appeal will involve collecting crucial evidence and formulating an effective and reasonable argument. A claimant must review and analyze claim records, denial letters, insurance policies, and other documents the insurance company provides or shares. A claimant will also need to produce convincing evidence to support their claim, collect and distribute all required documents and perform legal research.
Some of the documentation that your claim may require includes:
- Accident report
- Police records
- Insurance policy
- Coroner’s report
- Autopsy report
- Toxicology reports
- Death certificate
- Witness statements
A surviving beneficiary must present the documents listed above and other helpful items to prove their loved one was the victim of an accident that caused their death or dismemberment.
Preparing an administrative appeal takes a lot of work. It may be too much for someone suffering from the loss of a spouse, parent, or child and a challenging task for someone who has recently experienced a serious accident-causing dismemberment.
Call an Experienced Louisiana Insurance Dispute Lawyer Today
Employing the help of an experienced insurance claims attorney is beneficial, especially if the attorney is skilled in AD&D claims and appeals. Our team at J. Price McNamara ERISA Insurance Claim Attorney has the resources and the experience to prepare an effective strategy to fight for your beneficiary benefits.
Your loved one purchased and paid for an insurance policy with the expectation that you will have financial support when necessary. They expected the policy to protect you after their death. Insurance aims to protect the vulnerable, not to take advantage of their weakness.
Unfortunately, insurance companies take advantage of the vulnerable so they don’t have to pay large settlements. Fight back. Make sure your loved one’s expectation becomes a reality. Don’t allow the big companies to take advantage of your situation. Hire an experienced attorney who will work and fight to make sure you receive the benefits you deserve, the benefits your loved one paid for.
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Baton Rouge, LA 70809
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