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Denied ERISA Accidental Death and Dismemberment Claims

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Free Guide to AD&D

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Did you know that accidental death are the 5th leading cause of death in the United States? But, unfortunately, not every death may be covered under an AD&D policy.  What a covered accident can depend on the policy definition of “accident”, policy exclusions, the facts of the case and the law that governs the payment of benefits.    

You should never accept a life insurance carrier’s delay or denial of an AD&D claim without consulting with an experienced AD&D law firm such as our name.  You owe it to yourself to get a free 30 minute complimentary consultation because every unfair delay or denial is appealable and can be taken to court.   

What is AD&D Coverage?

AD&D is an abbreviation for accidental death and dismemberment coverage.  AD&D coverage, which is normally purchased with a life insurance policy, is bought one of two ways:

  1. As a separate AD&D policy, or
  2. As a rider to a life insurance policy.

 There are important differences between the two.

An AD&D policy will pay a benefit to the policy beneficiaries, if the policy holder dies in an accident or due to accidental means.

It can also pay a dismemberment benefit to the policy holder, if the policy holder loses one or more limbs, hearing or vision as a result of an accident or by accidental means. For example, dismemberment benefits can be paid if a motorcycle rider loses a leg or an arm as a result of a motorcycle accident.

On the other hand, a life insurance policy will pay benefits to the named beneficiary for most types of deaths, accidental or otherwise. A policy holder can purchase an AD&D rider to a life insurance contract that pays additional money to the beneficiary if the policy holder dies as a result of an accident or due to accidental means.

The rider is called a double indemnity and can pay double or triple the amount of the regular life insurance benefit.  The rider will pay dismemberment benefit to the policy holder when the policy holder loses one or more limbs, hearing or vision in an accident or by accidental means. A rider that is made part of a life insurance contract will cost more.    

Often, policy holders have both a life insurance and AD&D policy. If the policy holder dies in an accident, the life insurance company should pay both life insurance and AD&D benefits.

We can file a winning shock and awe life insurance and AD&D application that gives the carrier little reason to deny a claim.


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Has your ERISA AD&D Claim been delayed or denied? 

Many Americans an offered an employee benefit package that has group health, disability, life insurance and accidental death and dismemberment coverage, known as AD&D coverage. Most likely the insurance plan or policy is governed by a federal law that controls employee welfare plans. This law is the Employee Retirement Security Act of 1974 which is known as ERISA.

However, if you bought your own disability, life or AD&D policy or work for a governmental agency or church, the plan or policy is most likely governed by the law of the state where you live.

It is crucial that you know, from the very beginning, whether ERISA law or state law governs the claim

The ERISA claims process, appeal process and the

Litigation rules are completely different than the rules that govern a state law claim. Not knowing the difference can destroy a denied claim. We have the experience to help you get your benefits, regardless of whether the claim is governed by state law or ERISA law.

We’ll use the law to get a quick decision on your claim. 

What Are the Common Reasons An AD&D Claim Is Denied?

AD&D policies or life insurance riders have multiple exclusions that allow the insurance carrier to deny a claim for AD&D benefits.

You should understand these reasons BEFORE you file a claim.

The first set of reasons carriers used to justify a claims denial is that the death is not covered by the policy because the death was not an accident.  What is or is not an “accident” can be hard to determine and every harder to determine if the policy does not define the term “accident.”  Worse yet, the term “accident” might be unclear or ambiguous, yet the carrier hang their hat on that language.

The second set of reasons that life insurance carriers use to deny AD&D claims. The life insurance carrier might say, “Ok, you got us and the death was accidental. But, we aren’t going to pay since there is a policy exclusion. “  

Let’s look at some common policy language terms and the games played by carriers. As we do this, get out the policy holder’s AD&D policy, go to the definition section and see similar terms

  1. The policy holder’s death was an accident but was caused by alcohol or drug intoxication over the state legal limit.                                                                                                                                                                                                                                                                                                                                                                The game played is that life insurance carriers will rely on their own                                             toxicologist or medical experts to misinterpret the toxicology reports,                                                    misstate the level of the alcohol or drugs and then leap to the conclusion                                             the death was caused by the intoxication.           
  2. The policy holder’s death was due to suicide.                                                                                                                                                                                                                                                                                                                     The game played is that the life insurance carrier can claim the policy holder took                      their life deliberately. The law generally presumes that someone won’t kill                                                themselves. Absent a suicide note, life insurance carriers will cull medical records                                for complaints of depression, financial problems or marital problems that might                                                cause someone to kill themselves. The carrier will then leap to the conclusion                                    that policy holder’s death was caused by suicide.
  3. The policy holder’s death was caused by reckless behavior that a reasonable person would expect could result in death.                                                                                                                                                                                                                                                                                                                                                   The game played is that what a reasonable person might think is normal or even     risky isn’t in the view of the life insurance carrier. So, for example Ms. Cavey loves to                            ski and do back country skiing in the mountains of Colorado and Utah. She doesn’t think                               it is risky, but her life insurance company might think otherwise.                                                                                                                                                                                                                                                               On the other end of the spectrum, a policy holder may use narcotics with the      expectation of getting high but doesn’t expect to die. Life insurance companies                                     routinely deny these types of claims on the basis that a reasonable person knows                   they can die by using narcotics.
  4. The policy holder’s death was caused or contributed to by other medical illnesses.                                                                                                                                                                                                                                           The game played here is that the person died as a result of an illness and not an                                  accident.  A policy holder might have a heart attack while driving a car and hit a                                            tree which results in his death. Was the death caused by the heart attack or hitting a                         tree. The life insurance company will deny the claim on the basis that the death was                           caused by the heart attack.               

Is the insurance carrier using these or any other reasons to deny benefits?

Remember, the life insurance company wrote the policy and, often, did not define the very language they use to justify the claims denial. These policy terms are hard to understand and to apply. Don’t let a life insurance carrier get away with a wrongful denial.

At name of firm, we are the go to legal experts for wrongful AD&D claims. In fact, we have other law firms call us for help and refer cases to us, because they know we can get beneficiaries and policy holders the AD&D benefits they deserve.

Our referral partners trust us to fight the life insurance carriers and you should also.

Call today for a free consultation at phone number. Don’t delay. Make the call!  

What you need to know about Filing an Appeal of a Wrongful Denial of an ERISA AD&D Claim

ERISA requires a plan administrator or insurance company to administer a claim in the best interests of the participants and beneficiaries, like you.

When a plan or insurance company says “no”, we won’t pay, you will only have 180 days in which to file an appeal. Many people try to file an appeal on their own thinking that all it will take is a simple letter saying “we appeal” or that submitting more information will make the carrier pay. Not so!  You can’t submit any new information after the appeal period runs in an ERISA AD&D case.

Writing your own appeal is like preforming brain surgery.  

Having a personal injury lawyer, family lawyer, Social Security lawyer, criminal lawyer, divorce lawyer, estate lawyer write an appeal is like performing brain surgery  

You should hire an expert ERISA life and AD&D insurance attorney to file a winning shock and awe appeal. Your odds of getting the denied life insurance and/or AD&D benefits is greater if an ERISA attorney, like our name, files the appeal. That is a no brainer.   

What the Name of Our Firm Does To Appeal a Wrongful Denial

Before we file an appeal, we get, as needed:

  • Get the policy,
  • Get a copy of the carrier’s file,
  • Review the carrier file cover to cover
  • Review any carrier medical peer review reports, including toxicology reports,
  • Outline the evidence and reasons the carrier is using to justify the claims denial,
  • Obtain all of the medical records,
  • Obtain statements of the family and witnesses,
  • Conference any doctor’s the policy holder treated with prior to the death to any claim that any sickness or other medical condition contributed to or caused the death,
  • Consult with and retain a medical expert to address the cause of death,
  • Consult with and retain a toxicologist to address the intoxication exclusion,
  • Consult with and retain an accident reconstruction specialist,
  • Consult with and retain a motorcycle or ATV accident expert,
  • Research similar cases and policy denials in federal and state court to support our arguments.

We are known in the insurance business as filing shock and awe appeals and, if necessary, filing suit in state court and federal courts.  We attack the reasons that insurance companies use day in and day out to justify a wrongful denial of benefits.

Filing a Law Suit to Get the AD&D Benefits the Life Insurance Company Promised

ERISA and state law AD&D claims are tricky, medically complex and a legal minefield.

Insurance companies have little real sympathy and will deny a claim if they think they can get away with it. They are counting on your overwhelming grief and a hope that you will just give up and go away. They have only the policy limits to lose while you and your family have a way of life to lose.

Don’t let the life insurance company rob you of the life insurance benefits you need.

We know it can be difficult to make the decision to take on a huge nationwide life insurance company. You are afraid that it will costs lots of money and you may think you just don’t have the emotional energy to take them on.

At our firm name, we take cases on an affordable contingent fee basis which means that if we don’t recover benefits, we don’t get paid. It is a simple as that!

We take the stress out of litigation. It is our job to get you the benefits while you and your family heal.

Insurers are counting on you to submit an appeal that doesn’t attack the bogus reasons for the claims denial, failing to submit an appeal on time or at all, or failing to sue on time. Any one of these innocent and simple mistakes can cost you the AD&D benefits.      

We take on name of carriers every day and aren’t afraid of them.

If your life insurance or AD&D claim has been delayed for more than 30 days or denied, call us for help at phone number immediately. Delay is your enemy. Phone number.

Learn more about delayed or denied private life and AD&D claims next.

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