If you are one of the millions of Americans who pay premiums for accidental death and dismemberment insurance, you expect your policy to pay out if and when you need it to. However, several circumstances can change whether the insurance company pays such a claim or not. One of these circumstances is if alcohol is involved in an instance of death or dismemberment.
Insurance companies often take advantage of the intoxication exclusion for accidental death and dismemberment insurance to avoid paying out claims that involve any suspicions of alcohol use. If you or a family member were denied ERISA death and dismemberment benefits on the account of alcohol consumption, an experienced insurance attorney may be able to help.
An insurance policy is considered a contract between the insurance carrier and the insured. However, the insurance company can include various terms in their policy within the confines of federal and state laws.
Exclusions are common terms included in ERISA insurance policies, especially accidental death and dismemberment policies. These sections of policies may exclude deaths that occur at work or due to the gross negligence of the insured.
Some insurance carriers also have an intoxication exclusion. This means that if the insured is killed in an accident or needs to file a dismemberment claim, the insurance carrier may in certain states refuse to pay out on the policy if they determine the policyholder consumed alcohol or other intoxicating substances prior to their death or accident.
Each state has its own standing when it comes to insurance exclusion laws. Some have no regulations at all, instead opting to let individual insurance companies, claimants, and courts sort out these issues privately, while others specifically outlaw the practice.
There are many states that explicitly allow insurance companies to use this exclusion. ERISA insurance carriers are not legally mandated to cover any losses that result from the insured being intoxicated, or under the influence of drugs not prescribed to them by a physician.
Depending on how much alcohol was consumed and the specific situation, an insurance lawyer may be able to help claimants and their families access their accidental death and dismemberment insurance benefits. Some claimants may not have had enough alcohol or other substances in their system to have contributed to an accident.
For others, the insurance policy can be interpreted in more than one way. Insurance terms can be ambiguous, and certain parts of the contract may only apply to certain circumstances.
While it may seem easier to give up on a denied accidental death and dismemberment claim denial, this is exactly what the insurance carrier hopes you will do. If you fight your way through the confusion and advocate for your rights with the help of an insurance attorney well-seasoned in this area of the law, you may still be able to obtain benefits.
Any experienced AD&D insurance lawyer should be familiar with the tactics that insurance companies may use to attempt a claim denial, and they should also have practice in refuting their reasons. Do not give up on your attempts to get this claim covered for you or a family member. Call today to schedule a consultation and get the professional help you need.