Losing a loved one in an accident or suffering a life-changing injury is devastating. Accidental death and dismemberment (AD&D) insurance is meant to provide financial support during difficult times, but insurance companies often look for reasons to deny or reduce payouts.
A New Orleans accidental death and dismemberment lawyer can help you fight back.
Since 1990, ERISA Insurance Claim Attorneys have been helping families secure the benefits they need. With a strong track record of success, we have helped clients recover payments and move forward with confidence. Our New Orleans insurance claims lawyer will protect your best interests.
Call today for a free claim denial review.
Work With a Compassionate Accidental Death and Dismemberment Lawyer in New Orleans
For years, Price McNamara worked as an insurance company attorney, gaining firsthand knowledge of the tactics insurers use to deny rightful claims. Frustrated by how often they take advantage of people who deserve compensation, he decided to fight for claimants instead.
Now, as a New Orleans accidental death and dismemberment insurance claim attorney, he uses his insider experience to help families secure the benefits they are owed. His work is personal; after losing several loved ones, he knows the pain and frustration of dealing with a wrongful claim denial.
The Common Challenges of AD&D Insurance Claims
Filing an accidental death and dismemberment insurance claim can be difficult, causing stress and financial hardship. Our lawyer will help you understand how to handle these challenges and increase your chances of getting the benefits you deserve.
Denials
Claim denial is one of the main obstacles a claimant can face. Insurance companies deny claims for various reasons, such as claiming that the death or injury wasn’t accidental or fell under an exclusion in the policy. For example, insurers typically exclude deaths resulting from intoxication or pre-existing conditions.
Common reasons for denials include:
- Policy exclusions: Insurers may deny claims if the death or injury falls under specific exclusions, such as incidents involving intoxication, self-inflicted injuries, or non-accidental causes.
- Lack of documentation: Insufficient evidence to prove that the death or injury was accidental can result in a denial. Missing medical records or accident reports may contribute to this issue.
- Pre-existing conditions: Insurers may deny claims if they believe the injury or death was due to a pre-existing condition rather than an accident.
- Late filing: Delays in submitting claims or required documentation can lead to automatic denials based on procedural grounds.
Delays
Delays in processing claims are another major issue. Insurance companies may request extensive documentation, medical records, and proof of the accident’s circumstances, leading to lengthy processing times.
In Louisiana, specific state regulations, such as RS 22:1892, require insurance companies to acknowledge claims and begin investigations promptly, but delays can still occur due to complex bureaucratic processes.
Louisiana’s unique legal landscape can also impact AD&D claims. For example, the state’s community property laws can affect the distribution of insurance benefits in the event of a policyholder’s death.
Appealing a Denied Claim
If an insurer denies your claim, our New Orleans accidental death and dismemberment insurance claim lawyer will guide you through the appeals process. Your attorney can challenge denials based on misinterpretations of policy language or procedural errors.
If your AD&D insurance claim is denied, take the following steps to improve your chances of overturning the decision:
- Review the denial letter: Carefully examine the denial letter to understand the insurer’s reasoning. This letter typically outlines the specific grounds for denial and the evidence considered.
- Consult the policy: Revisit the policy terms and conditions to ensure the insurer should cover the claim and to identify any possible misinterpretations by the insurer.
- File an appeal: Most insurance policies provide an appeals process for denied claims. This process usually involves submitting a written appeal, providing any additional evidence, and outlining why the insurer should reconsider the claim.
- Move on to administrative appeal: The initial step usually involves an internal review by the insurance company. Submit a comprehensive appeal with all relevant documentation.
- Ask for an external review: If the internal appeal is unsuccessful, policyholders may request an external review by an independent third party, as allowed under the Employee Retirement Income Security Act (ERISA) regulations. ERISA applies to AD&D policies offered by employers.
- Litigation: If all appeals fail, the final recourse may be to file a lawsuit against the insurance company. A New Orleans accidental death and dismemberment insurance claim attorney can evaluate the viability of ERISA litigation and represent you in court.
Policyholders can effectively challenge an AD&D claim denial and pursue the benefits they’re entitled to by understanding the reasons for denial and hiring our AD&D lawyer as soon as possible.
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How Federal and State Laws Impact ERISA and AD&D Insurance
Filing an accidental death and dismemberment insurance claim can be complicated, especially when both federal ERISA regulations and Louisiana state laws come into play. Our accidental death and dismemberment attorney in New Orleans has a deep understanding of how these laws interact.
The Interaction Between ERISA and Louisiana State Laws
ERISA sets the federal standards for most employer-sponsored benefit plans, including AD&D insurance. It preempts state laws, meaning that federal laws supersede state-specific rules. However, Louisiana state laws can still play a role in areas not explicitly covered by ERISA or in providing additional protections.
For example, while ERISA governs the administration and fiduciary responsibilities of AD&D plans, Louisiana’s insurance regulations may also come into play.
While rare, these regulations sometimes influence policy terms, coverage stipulations, and dispute resolutions. In addition, state laws on community property and inheritance can affect the distribution of benefits.
The Influence of Federal ERISA Guidelines
ERISA’s primary influence is ensuring that plan administrators act in the best interests of the participants and beneficiaries. This includes adhering to fiduciary duties, providing transparent disclosures, and following strict claims and appeals procedures.
These federal guidelines dictate how AD&D claims are processed, with specific timelines and procedural requirements that must be met to avoid penalties and ensure fair treatment.
If an insurer has denied your employer-sponsored claim, ERISA Insurance Claim Attorneys can ensure the policy complies with all relevant mandates. If it doesn’t, we will fight to help you get the money you have coming.
Our ERISA Lawyer Can Guide You Through the Process
AD&D insurance claims often fall under the purview of ERISA, a federal law designed to protect employees’ benefits. Our New Orleans insurance claim attorney can ensure fair treatment and help you get the benefits you need.
ERISA regulations are intricate, with numerous procedural requirements. Key complexities include:
- Fiduciary duties: Plan administrators must act prudently and solely in the interest of plan participants, which involves rigorous adherence to the plan’s terms and ERISA standards.
- Claims and appeals process: ERISA dictates specific timelines and processes for claims and appeals. Failure to follow these can result in denied claims or forfeiture of benefits.
- Disclosure requirements: ERISA also requires detailed disclosures to plan participants about their rights, benefits, and the claims process.
ERISA sets standards for most voluntarily established retirement and health plans in private industry to protect individuals in these plans.
For AD&D insurance claims, ERISA mandates that plan administrators adhere to specific fiduciary responsibilities, ensuring they act in the best interest of the plan participants and beneficiaries. This includes the fair processing and timely payment of claims.
Call a New Orleans Accidental Death and Dismemberment Attorney Today
Don’t try to deal with the complications of AD&D insurance claims alone. Contact our New Orleans accidental death and dismemberment insurance claim attorney today to give yourself the best chance of receiving benefits.
ERISA Insurance Claim Attorneys provide the guidance and support you need. From initial claims to challenging denials, we will protect your rights and maximize your benefits.
Call now for a consultation and take the first step toward securing the financial protection you and your family need.