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New Orleans Insurance Dispute Attorney for Accidental Death & Dismemberment Insurance Claim Denials

Accidental Death & Dismemberment (AD&D) Insurance is a relatively inexpensive insurance policy that will pay its face value (and sometimes twice that) for your death in an accident or a lesser amount for the loss of certain senses or body parts. You can buy it as a standalone individual policy or from your employer as part of its cafeteria benefits menu. If the latter is the case, your plan and its administration are subject to a complicated federal law called ERISA.

If you or a loved one is experiencing difficulties or bad faith in getting an AD&D claim paid, work with an Accidental Death & Dismemberment attorney. J Price McNamara concentrates his practice in, among other things, bad faith insurance claims. He can help you bring your claim to the insurance company or a courtroom to obtain the best possible resolution for you. Contact us today for help appealing your denial.

Injury Risks in New Orleans

The leading cause of accidental death and injury in Louisiana is car accidents, mostly caused by driver negligence. Other frequently seen injuries can include construction site injuries, slip-and-fall injuries, animal bite injuries, and many others, any one of which can, under the right circumstances, result in an AD&D claim. Construction sites are dangerous in any city and tend to come and go, making it difficult to proscribe those areas.

Business Insider rates the intersection of Canal Street and North Dorgenois Street in New Orleans the most dangerous corner in Louisiana for traffic accidents. Dangerous neighborhoods where one can easily sustain injuries due to crime include the Saint Roch area, the Seventh Ward, and the Saint Claude neighborhood.

AD&D Is Not the Same as Life Insurance

A life insurance policy is one that, with very limited exceptions, pays off when you die regardless of how you die. Life insurance generally does not address non-fatal injuries in any way. In contrast, an AD&D policy only pays off if you die in an accident or lose one of the specified senses or body parts. If added to a life insurance policy, AD&D coverage may be referred to as double indemnity because it will pay the full face value of the policy, over and above what the life policy pays, in the event of accidental death.

The Insurance Company’s Obligation to Pay

When you file a claim on any insurance policy, the insurance company that issued the policy has certain duties or obligations to you. The first and most important is that the company must act with good faith when handling a claim, thoroughly investigate all claims, respond promptly to your claim, pay or deny all claims within a reasonable time and, if denying a claim, provide a reasonable written explanation for the denial.

The courts take delays of payments in Louisiana as evidence of bad faith on the part of the insurance company. This stern stance is because of the severe property and casualty damage often experienced in New Orleans due to frequent severe hurricanes.

Issuer Denial Strategies

bbb a+ badgeAD&D insurance companies will frequently attempt to deny a claim for benefits, arguing that the evidence supporting the claim is weak or that the death was not accidental.

An insurer may try to deny your claim if the death comes too long after the accident or where the insurance company can show you were negligent in causing your accident. The insurance company may also deny coverage based on its allegation that you had a stroke or heart attack, which actually caused the accident and arguably made the death the result of the medical condition.

Common Exclusions on AD&D Policies

AD&D policies often have many specified exclusions. Those exclusions are often open to interpretation, giving the insurance company an advantage if trying to deny your claim.

Some of these exclusions are:

  • Intoxication as a cause of your accident
  • Abuse of prescription or illegal drugs as a cause of your accident
  • Pre-existing condition as a cause of your accident
  • Medical treatment caused the death or disability
  • Criminal activity as a cause of your accident
  • Suicide
  • Pregnancy or illness at the time of the accident
  • Heart attack or stroke leading to the accident
  • Professional athletic injuries

Arguing that any of these were part of the cause of the accidental death or dismemberment may give the insurance company a plausible reason for denying your claim. They may also argue that there were no witnesses to your claim or that the death occurred too long after the accident for it to be the cause of death.

Bad Faith Failure to Pay

Under Louisiana’s bad faith insurance laws, an insurance company is acting in bad faith in handling a claim if its actions are arbitrary, capricious, or without probable cause. An insurance company that fails to handle your claim in good faith is subjecting itself to potential punitive damages.

In other words, if the insurance company’s denial, delay, or settlement of a claim is unjustified or lacks a reasonable basis, the company could be subject to penalties for acting in bad faith.

The claimant may recover the full amount of the claim and the greater of up to twice the actual damages or $5,000. Thus, if you had a $1 million claim and the insurer handled it in bad faith, you may ultimately recover $3 million, your original damages, plus two times those actual damages.

Appealing a Denial of a Claim

If your employer supplies your AD&D insurance, it is subject to ERISA, and you must follow the very detailed requirements of ERISA to file an appeal or a lawsuit. Among those requirements is a mandatory administrative appeal. If the insurance company also denies that appeal, you may file a civil lawsuit.

A knowledgeable lawyer can help you comply with these requirements and the narrow deadlines that can apply to them. That same lawyer can make sure your claim is well developed and that you have the appropriate evidence to support it.

If your policy was individually purchased or was a rider to your life insurance policy, then ERISA does not apply. In that case, state law applies rather than ERISA, and you should follow your state’s procedures. Your AD&D attorney will understand what your options are in your state. Again, the requirements can be complex, and the time windows are brief, so using an attorney may be your best decision for finally receiving your damages.

FAQs AD&D

Q. Is Accidental Death & Dismemberment insurance a good substitute for term life insurance?

  1. No. AD&D pays benefits if you die in one of the accidents delineated in your policy. It will also pay a percentage of the policy face value if you lose one of the designated limbs or senses. However, if the insured dies from an illness rather than an accident, or if the death took place so long after the injury as to create causation questions, coverage may not apply.

Whether it’s term life or whole life, a life insurance policy pays off on virtually any cause of death except, perhaps, for suicide within a short period of the policy purchase.

Term life is much less expensive than whole life and can be very useful for young families just beginning to create assets, but with potential expenses on the loss of the breadwinner. It allows for the purchase of far more insurance than the same money would buy in whole life.

Think of AD&D as just an add-on to that coverage, not a replacement for it. AD&D leaves a huge coverage gap in the event of death by illness.

Q. What happens if I’m making an AD&D claim and the death certificate says “natural causes” for the cause of death?

  1. Generally, under those circumstances, your claim for AD&D damages will likely be denied. You can appeal and present evidence that your loved one did not die of natural causes regardless of what the death certificate says.

Q. What types of coverage can you purchase for AD&D?

  1. There are single or family-coverage policies. Family coverage protects you, your spouse, and your dependent children.

Q. How can you receive benefits under an AD&D policy?

  1. Once a claim is made and approved, the insurance company makes a tax-free benefits lump-sum payment to your beneficiaries.

Q. What is AD&D insurance?

  1. Accidental Death & Dismemberment insurance is a policy that pays the policy beneficiaries in the event of an insured’s qualifying accidental death. It does provide coverage in the case of death from illness or other natural causes. It may pay a portion of the face value benefits of the policy if you lost sight or hearing, or a digit or limb, as defined by the policy.

Q. Does it matter where I get my AD&D insurance?

  1. Yes, it does. Generally, ERISA governs policies purchased through work. If you purchase it yourself in the open marketplace, the policy will be governed by your state’s insurance rules and regulations. Further, your benefits will be taxable income if your employer pays the premiums. If you pay your own premiums, the benefits paid will be tax-free.

Q. Can you collect benefits from both a life insurance policy and an AD&D policy?

  1. If both policies would cover the cause of death, you may collect on both policies. This situation is no different than if you had two life insurance policies purchased from different companies at different times. Both would pay upon your death.

Q. Will an AD&D policy cover death from a sudden catastrophic illness?

  1. No. An AD&D policy covers your death (or dismemberment) in the case of an accident, not an illness, no matter how sudden or catastrophic it may be. It will also not cover cancer, COVID-19, AIDS, or any other illness.

Q. Is AD&D insurance expensive?

  1. Relatively speaking, AD&D insurance is much cheaper than term or whole life insurance. However, it also provides much narrower coverage than either whole or term life and therefore should cost less.

Q. Will an AD&D policy cover any and every accidental death?

  1. No. Generally, if the insured is in an accident resulting from acts of war or the insured’s felonious conduct, then the AD&D policy will not pay off. Most policies also will not cover accidents resulting from a pre-existing condition or self-inflicted harm. Negligence in an otherwise coverable accident may also defeat your claim. For example, not wearing a seat belt may cause a denial after a car accident. It may exclude high-risk activities like skydiving and extreme sports.

Let a New Orleans AD&D Insurance Attorney Help You Today!

If dealing with a denied claim from CIGNA long term disability, consult with a skilled Macon insurance benefits attorney.
New Orleans Insurance Dispute Lawyer, J. Price McNamara

If your insurance company is denying your claim or dragging out negotiations on your claim, contact J. Price McNamara ERISA Insurance Claim Attorney to get them moving. Call us at (504) 420-6962 for a no-cost initial consultation on your AD&D denial case.

We have extensive experience dealing with insurance companies in these same kinds of cases—and we aren’t afraid to do it again.

Appealing a denied AD&D claim, whether your plan is subject to ERISA or state insurance rules, can confuse anyone. And you must do it very quickly or miss important deadlines. Skilled and experienced claims denial attorneys can help you through this process and ensure that your beneficiaries receive the benefits they are entitled to under your accidental death and dismemberment insurance policy.

  1. Price McNamara ERISA Insurance Claim Attorney has extensive experience handling AD&D claims and claims denials. We understand how insurance companies deny these claims and will use that experience and understanding to advocate for your benefits under the denied claim. Don’t let your chance to recover the benefits you deserve pass you by.

New Orleans Office

829 Baronne Street
Suite 2B
New Orleans, LA 70113

Phone: (504) 420-6962
Fax: (225) 201-8313
(By Appointment)

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“Price is very professional, honest, and reliable. Whatever he says, he will follow through with the utmost integrity. He will turn over every stone and pays close attention to even the smallest detail.”