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$1,300,000 Trial Verdict in ERISA Accidental Death and Dismemberment Insurance Denial Lawsuit My client’s cause for an ERISA accidental death and dismemberment…
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.
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.
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.
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.
AD&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.
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:
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.
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.
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.
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.
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.
829 Baronne Street
New Orleans, LA 70113
“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.”
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts