Texas Insurance Dispute Lawyer for Accidental Death and Dismemberment Insurance Claim Denials

It is easy to purchase an Accidental Death and Dismemberment (AD&D) insurance policy, but it is often quite difficult to have that policy award benefits if a loved one accidentally dies. It is common for big insurance companies to deny payments for AD&D policies. The monetary benefits of AD&D insurance are significant, and most insurance companies will try to avoid paying benefits by whatever means necessary. If you or a loved one has been denied benefits after losing a loved one to an accident, you will want to speak with a Texas insurance dispute lawyer. An experienced texas insurance dispute lawyer for accidental death and dismemberment can handle your claim and help you receive the benefits you are entitled to. At J. Price McNamara ERISA Insurance Claim Attorney, we have successfully handled many AD&D claims and appeals. We bring the same dedication and experience to every case and are ready to help you.

Table of Contents

What is AD&D Insurance?

Usually added to a life insurance policy, accidental death and dismemberment insurance is an inexpensive rider that most people purchase. An insured’s beneficiaries, including a surviving spouse, child, or parent, will receive a lump-sum payment if the policyholder should perish due to an accident. Insured individuals will receive living benefits if an accident causes dismemberment, including loss of bodily function, loss of limbs, or use of limbs. Many employers provide AD&D insurance at low rates as an employee benefit. An AD&D policy will pay full benefits if the policyholder dies accidentally. An AD&D policy will also pay benefits when an insured loses eyesight, hearing, or a limb because of an accident. As we know at J. Price McNamara ERISA Insurance Claim Attorney, these providers do not always pay out benefits as they should. The Employee Retirement Income Security Act of 1974 (ERISA) protects this employer-provided insurance. This act outlines minimum standards for most voluntary health and retirement plans in private industry to protect the individuals enrolled in these plans. The unique and complex nature of AD&D insurance makes it necessary and worthwhile to obtain legal counsel before filing your initial accidental death or dismemberment claim. An attorney familiar with ERISA can ensure the proper completion of your AD&D claim and provide you with the best foundation for an AD&D claim. Accidental death and dismemberment riders are also called “double indemnity” riders. This means that when a policyholder dies due to an accident, his or her beneficiaries should receive life insurance and accidental death policy benefits. This equals the original life insurance policy’s face value times two. We achieved a trial verdict of $1.3 million for one client who received a denial of benefits following a tragic accident. Insurance benefits for dismemberment will provide smaller benefits. The insurance company only pays a percentage of the original life insurance policy’s face value for the loss of sight, hearing, or speech, partial or permanent paralysis, or the loss of a specific body part or limb. There are important things to note about AD&D insurance policies, including:
  • AD&D insurance is usually an addition to a life insurance policy. Employers often include this option with their benefits package.
  • AD&D insurance benefits apply when the policyholder dies because of an accident or dismemberment, including the loss of functions.
  • Coverage limitations are in every AD&D policy. Reviewing your policy to know what is and isn’t covered is important.
  • A death due to natural causes does not fall under AD&D insurance. Only accidental deaths have coverage.
  • Beneficiaries may receive two times the face amount of the insured’s life insurance policy, which includes the actual life insurance and the AD&D insurance. Dismembered individuals will receive a percentage of the face amount of their regular life insurance, depending on the extent of their injury.
If you have any questions, please reach out to J. Price McNamara ERISA Insurance Claim Attorney for help today.

How to File an Accidental Death Claim

You must file an accidental death claim if your loved one has died because of an accident, and you are the beneficiary. You will be required to provide the claims examiner or adjustor with accident reports, medical records (both before and after the accident), witness statements, prescription information (from before and after the accident), toxicology reports, autopsy report, coroner’s reports, and death certificates. They might request other required items as well. The insurance company may delay or deny your claim if anything is missing or inaccurate. You can avoid problems by providing all necessary documentation upfront. An insurance lawyer from J. Price McNamara ERISA Insurance Claim Attorney can help you with this task and help prevent the insurance company from denying your benefits.

AD&D Claim Denials

bbb a+ badgeEven when premiums are up to date and policyholders and beneficiaries have protections under ERISA, many AD&D claims get rejected. The claims process for AD&D insurance tends to be confusing and overwhelming. Claims dismissals often happen because something is missing. Simple mistakes may be the reason for denial. If this happens to you, an experienced ERISA Accidental Death and Dismemberment insurance lawyer can help. AD&D benefits tend to be considerable when there is an accidental death claim. Double indemnity means big payoffs. Insurance companies will attempt to avoid paying benefits to the insured’s beneficiaries because of the significant amounts. Big companies may manipulate grieving families and victims who have suffered dismemberment. They will try to take advantage and use whatever means necessary to deny benefits. They count on victims’ and survivors’ lack of knowledge and energy to fight the denied or delayed claim. An insurance dispute attorney with AD&D experience will take on that fight and work toward a fair settlement. Reach out to J. Price McNamara ERISA Insurance Claim Attorney today.

Reasons for Your AD&D Claim Denial

Insurance companies may not cover accidental alcohol or drug abuse-related deaths. Beneficiaries and survivors not only have to deal with the grief of losing a loved one, but they also have to deal with litigation and overwhelming administrative tasks to fight for their rightful benefits. Insurance companies are objective parties. They do not necessarily care about the heartache and grief of the beneficiaries, as they claim to do. They often only care about the money and will do what they need to prevent big payouts to AD&D beneficiaries.

What to do if you receive a claim denial

Insurance companies deny most claims. You can file an administrative appeal if an insurance company does not honor your claim. This is a critical and complex appeal process that you must carefully navigate. Simple mistakes can cost you dearly. Our experienced AD&D insurance attorneys can help you. The federal ERISA monitors accidental death insurance claims, particularly claims involving employer insurance plans and packages. The ERISA accidental insurance claim appeal is very confusing and time-consuming. The insurance company and its legal representatives understand the workings of this appeal system, but you may not be. Hiring a lawyer with extensive experience in AD&D claims and appeals will benefit you. Experienced attorneys can plan accordingly, prepare an effective argument, and help relieve the stress you are already encountering due to the changes in your life. Unfortunately, many survivors and beneficiaries file ERISA administrative appeals without the help of an attorney, and their claims usually remain denied. This one administrative appeal is your only chance to build your case. You must take time to carefully collect crucial evidence and proof. This is the sole evidence to establish your case if and when it goes to court. The evidence presented at this time becomes the legal record of your claim. Additional information or evidence will not be allowed in court. You will lose your case and benefits if you are unprepared or unorganized. Avoid this risk by hiring J. Price McNamara ERISA Insurance Claim Attorney to help with your appeal.

How Does the Appeal Process Work?

Below, you will find the steps for the AD&D appeals process.
  1. The beneficiary files the initial claim for AD&D benefits and receives a written denial from the insured’s insurance company.
  2. An administrative appeal must happen through the insurance company if ERISA governs your claim. (You do not need to follow the appeal process if ERISA does not govern your accidental death insurance.)
  3. You must file an administrative appeal within 60 days of the denial’s receipt. If you miss this deadline, you will lose your chance to appeal and seek benefits.
  4. The insurance company will decide if they will reverse their decision and pay your benefits.
  5. Insurance companies often deny appeals. At this point, there is no option but to file a lawsuit in a federal court.
ERISA cases do not follow the usual insurance protocols. They have their own rules and regulations, making things even more confusing for a claimant. That’s why it is wise to seek the counsel of an experienced ERISA lawyer. They will be privy to the distinct characteristics of this type of litigation and can represent you professionally and defend your interests. It is important to know that ERISA cases do not follow typical federal protocols. They have their own set of rules. An experienced ERISA lawyer will be comfortable with these intricacies 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; only evidence previously given during the administrative appeal is allowed. That’s makes getting things right the first time essential, and J. Price McNamara ERISA Insurance Claim Attorney can do that for you. Getting the administrative appeal right includes collecting crucial evidence and establishing a solid and reasonable argument. To do this, a claimant needs to review and analyze denial letters, claim records, insurance policies, and any other documents the insurance company provides. Claimants must also find convincing evidence to support their claim, perform legal research, and assemble all pertinent documents. Documents needed will include:
  • Death certificate
  • Insurance policy
  • Coroner’s report
  • Autopsy report
  • Accident report
  • Police records
  • Toxicology reports
  • Witness statements
The surviving beneficiary must produce those documents and other helpful items to prove there was an accident. As with any legal process, you need to discuss the situation with an experienced attorney so they can take the proper steps. You do not want to miss the deadline to file an appeal. This is a large amount of work for someone devastated by the loss of a spouse, parent, or child or someone who has lost a limb or the ability to see or hear. In this case, it will be beneficial to employ the help and experience of a reputable insurance attorney. It will help if that attorney has specific knowledge of ERISA AD&D claims and appeals. An experienced AD&D insurance attorney will have the resources and experience to fight for your rights to beneficiary benefits.

Call an Experienced Texas Insurance Dispute Lawyer Today

Accidental Death and Dismemberment Insurance Lawyer, J. Price McNamara
If you or a loved one purchased and paid for an AD&D policy, you expect that the policy will help protect you and take care of your family in the unlikely event of accidental death or severe injury. Insurance intends to protect those vulnerable, not take advantage of their vulnerability. Sadly, insurance companies will do just that to avoid big payouts. Don’t let them get away with it. Call an experienced AD&D insurance lawyer at J. Price McNamara ERISA Insurance Claim Attorney today at our Texas office at (713) 300-0462 or contact us through our website. Make your loved one’s expectation a reality, and don’t let the big companies take advantage of your vulnerability. Hire an attorney who will win you the benefits you deserve.

Houston Office

2000 Crawford St Suite 1649 Houston, TX 77002

Phone: (713) 300-0462 Fax: (225) 201-8313 (By Appointment)

Our Testimonials

"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."