It is difficult to recover from the loss of a beloved family member, but when a loved one dies under circumstances that are sudden and unforeseen, the pain can be even greater. Too often, valid death and dismemberment claims are denied because of avoidable problems with the claim submission. If you have experienced such a loss, it is important to ascertain whether the deceased was covered under an accidental death and dismemberment insurance policy.
Accidental death and dismemberment insurance can be very confusing, and it is different from life insurance. We’re here to help. No matter the situation, you deserve to have someone fighting for you to be sure that as a survivor you receive adequate financial support for your loss.
What Is Accidental Death and Dismemberment Insurance?
Accidental death and dismemberment (AD&D) insurance differs from life insurance in that it pays out to a beneficiary when the policyholder passes away due to an accident, such as a car crash. An AD&D policy does not usually provide benefits if the policyholder passes away due to an illness or other natural causes.
There needs to be an intervening accident, although the meaning of what constitutes an “accident” is rarely defined in insurance policies. Circumstances where coverage is unavailable would include sudden death due to a heart attack or stroke or even, in most situations, death that results from an illness such as COVID. However, even those situations may be covered if there is a concurrent event that was itself the cause of death. Although the law on this point varies in different jurisdictions, a heart attack may cause someone to lose control of a car and crash. If the injuries from the collision rather than the heart attack are the cause of death, AD&D coverage may be available.
The following are other circumstances where accidental death or dismemberment insurance coverage may be available, even if there is an underlying illness:
- Situations where the illness might cause a drowning in a body of water or even a bathtub
- Losses due to the stresses of scuba diving or mountain climbing
- Situations where a non-fatal accident can trigger a chain of events resulting in death.
- Death caused by a pulmonary embolism following surgery or immobility after an accidental knee injury
- Lengthy air travel resulting in a fatal pulmonary embolism
- Accidental overdose of prescription medication
How to Challenge a Denial of Accidental Death and Dismemberment Insurance Benefits?
When sudden deaths occur, there is usually an autopsy performed by the local coroner or medical examiner’s office. Under guidance issued by the Centers for Disease Control in a manual entitled “Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting, the” “manner of death” is to be listed as “accidental” on a death certificate if “there is little or no evidence that the injury or poisoning occurred with intent to harm of cause death. In essence the fatal outcome was unintentional.” It is difficult to challenge an AD&D denial where the manner of death is listed as natural. Obtaining a copy of the autopsy report in support of a claim for accidental death & dismemberment insurance is critical, as is obtaining any police reports if a law enforcement investigation was performed.
Chicago AD&D Insurance Lawyers
While no amount of money can provide sufficient recompense for the sudden and unexpected death of a family member, a denial of accidental death and dismemberment insurance coverage can worsen the pain of the loss. Just because the insurance company says no, though, that does not mean the answer is final. Consult with an attorney who understands how AD&D policies work and the experience in successfully challenging a wrongful denial.
Know Your Rights
Denials often result from policy exclusions. An insurance company may challenge whether a sudden death is accidental or deem an injury self-inflicted, even when the claim is payable.
Our team has the experience to disprove their claim denials and get you the relief you need.
Does This Apply to You?
Contact DeBofsky Sherman Casciari Reynolds P.C. for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Standard of Review
This matter involved a claim for accidental death insurance, but before addressing the merits, the court first needed to determine the applicable standard of review. The court accepted the arguments of DeBofsky shareholder William Reynolds that the more favorable de novo standard applied.
Disabilities Policies ERISA Ruling
DeBofsky Sherman Casciari Reynolds P.C., recently won a remand from the U.S. Court of Appeals for the Seventh Circuit in Hennen v. Metro. Life Ins. Co. Susan Hennen suffered from chronic low back pain radiating into her legs, despite having undergone three back surgeries…
Fibromyalgia ERISA Ruling
DeBofsky Sherman Casciari Reynolds P.C., along with Bridget O’Ryan and O’Ryan Law Offices won a victory in the U.S. Court of Appeals for the Seventh Circuit on May 18, 2017 in the case of Cathleen Kennedy v. Eli Lilly & Co. The case involved a disability benefit claim…
Experienced Attorneys Fighting For You
The most important thing to do if a claim for accidental death and dismemberment insurance is denied, though, is to immediately hire a knowledgeable and experienced attorney. If the insurance was provided through the deceased’s workplace, it is likely to be governed by the federal Employee Retirement Income Security Act (ERISA). Such claims can be complex; and the failure to hire a lawyer to assist in appealing the claim denial may preclude the admission of supporting evidence in court. It may also be necessary to hire experts such as a forensic pathologist or toxicologist to assist in investigating accident scenes and building the case; and an experienced and knowledgeable attorney can assist in locating such expertise and utilizing such evidence to effectively establish the insurance company’s liability.
As your attorneys, DeBofsky Sherman Casciari Reynolds team will guide you and navigate a complex insurance, legal and investigative process for you. We will defend your rights and advocate for you at every step.
The DeBofsky Sherman Casciari Reynolds attorney go to great lengths for our clients, and we are committed to examining every aspect of each case that we handle in great detail. With over 60 years of combined legal experience and a proven record of success in insurance and benefits denial cases across the U.S., our Chicago-based law firm will help you take all the right steps in helping you submit the application, appeal, and engage in the litigation process. We will protect your rights and aggressively advocate for your full compensation.
Here for You at a Difficult Time. Let Us Be Your Guide.
If your life or accidental death claim is denied, you may not realize you can appeal prior to going to court. Indeed, if your benefits are subject to the ERISA statute, you must appeal prior to filing suit or your case may be dismissed.
Insurance companies count on people not understanding the law, and not understanding the specific procedure to appealing a denied life or accidental death claim. Our expertise in ERISA and bad faith law lets us anticipate the insurer’s every move and guide you to the desired outcome.
Once we accept your care for representation, we will effectively present your case and work toward getting the denial overturned. We don’t stop until you get a fair hearing.
“I feel like I got the perfect person in you to get the job done.”
“Hi Martina. I wanted to thank you for representing me with my disability case. I couldn’t have moved forward without you. When I was frantic and feeling hopeless, you made sure to call me and had a way of calming my anxiety. This was the most difficult thing I’ve gone through in my life. You made it bearable for me. This was a tough case and needed an attorney that really knew how to negotiate with the big insurance company’s attorneys. I feel like I got the perfect person in you to get the job done.”
Linda m | Client
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