Accidental Death Insurance: How to Handle Claims
What is Accidental Death Insurance?
Accidental death and dismemberment insurance, AD&D for short, may pay benefits when an accident causes:
- Loss of limbs or fingers.
- Loss of speech, eyesight or hearing.
- Prolonged coma.
There may be other conditions which will allow you to collect benefits, depending on your policy.
How do I get Accidental Death and Dismemberment insurance?
An AD&D policy can be bought either privately or may be part of your employee benefits package. Privately bought AD&D policies typically come as an additional feature on a life insurance policy. A policy may also be bought alone as a cheaper alternative to life insurance, but with more restrictive coverage. Privately purchased policies are generally governed by Texas State insurance laws and regulations. When an AD&D policy is received as a benefit through your employer, they often fall under Federal Law, which can make claiming your benefits much more difficult.
How do AD&D claims work?
When a loved one has been killed in an accident or you have suffered a severe injury from an accident, you will have to file a claim with the insurance company to receive benefits. This process includes:
- Notifying the insurance company of the claim.
- Submitting a written claim with completed forms and supporting documentation by the deadline.
- Receive benefits or a response with detailed reasons for a denial.
- If your claim is denied, you will need to file an appeal by the deadline.
- If the appeal is successful, you will receive your benefits otherwise, you will receive confirmation of their reasons for denying the claim.
- If your claim is denied on appeal, your only recourse for receiving your benefits is filing a lawsuit.
Why did they deny my claim?
Most AD&D policies do not require a medical exam and are generally inexpensive compared to life insurance policies. For those who are denied life insurance or cannot afford life insurance, they are often marketed as an alternative. Employers also take advantage of the low premiums, by offering them as an enticing benefit at a very low cost. Denial of claims is very common. Many times, the reasons for the denial are not based in fact, but instead are speculation by the insurance company. Common denial reasons include:
- Pre-existing medical conditions.
- Medical treatment received.
- Substance or drug abuse.
- No witnesses.
- When the accident occurred.
- That the incident wasn’t an accident.
The insurance carrier will focus on anyway to disconnect the accident from the death or injury in order to deny your claim.
Do I have to file an Appeal?
The short answer is: not always.
It depends on your specific policy. If you received your policy from your employer, chances are it is an “ERISA” protected plan that will require you to file a formal Administrative Appeal before you can file a lawsuit. If your policy was bought privately, as either part of a life insurance policy or all by itself, you may be able to skip the appeals process if the policy allows for it.
Do I need an attorney to file my AD&D claim?
An attorney can present your claim in the best light possible, ensuring that all the correct documentation is attached from the beginning. They will remedy common issues and problems that could result in claim denial. The insurance carrier may also look at your claim with greater care, as they know you will be pursuing the matter vigorously to receive your benefits. A denial of your benefits when you are counting on them the most is a very serious financial blow.
Can I afford an attorney to file my claim?
The insurance carrier is counting on several factors to keep their amount of paid claims low by denying your claim. The shortlist of their tactics includes:
- Complicated policy language and procedures.
- Missed deadlines.
- You not understanding your policy’s exclusions and limitations.
- Overwhelming you with requests for documents and information at a time when you can least endure it.
- You being intimidated into dropping your claim.
- Convincing you that your claim was denied for a reason you can’t overcome.
- You giving up because you cannot figure out the next step towards receiving your benefits.
An attorney can assist you to overcome these obstacles and help you find the path to receiving your benefits. Many law firms throughout Texas, and in particular Houston, offer a wide range of ways to pay for an attorney, including a contingency fee which you don’t have to the pay attorney until they make a recovery for you. In such cases, the cost of an attorney makes sense when compared with losing the benefits. The receipt of the benefits will far out-weight the cost of an attorney.
The truth is you can’t afford to be without an attorney once your claim has been denied.
At a time when your life is in turmoil due to a tragic accident, an attorney leading you through this process is a bright light guiding you through the storm. Grief, loss and daily struggles have you at a disadvantage. Don’t let the insurance companies take advantage of you, get an attorney on your side today.