Accidental Death & Dismemberment Insurance Denial Lawyers
Has your accidental death and dismemberment claim been denied?
While most insurance denial claims are usually based on a misrepresentation made in the policy application, often a denial of an accidental death and dismemberment insurance, often called AD&D insurance, is made based on the strict interpretation of the specific wording of the policy. While you may think you have broad coverage under your accidental death and dismemberment insurance policy, the wording of these policies are intentionally drafted to apply narrowly to very specific circumstances and to exclude more common injuries and accidents.
What is Accidental Death & Dismemberment Insurance?
Accidental death and dismemberment insurance pays out lump sum benefits for loss of life and serious injuries like loss of a limb (or loss of use of limb), loss of eyesight, loss of hearing, loss of speech, amongst other serious injuries, that results from an accident.
It may seem obvious as to what is or is not an accident, but as with many things when it comes to the legal world, when it comes to accidental death and dismemberment insurance what is or is not an accident is a complicated question that even the Courts have a hard time defining. For denied accidental death and dismemberment insurance benefit claims the definition of what is an “accident” will be strictly interpreted pursuant to the terms of your policy. You may be surprised what is or is not considered an accident pursuant to the terms of your policy when you end up submitting your claim to your insurer.
What Is Covered Under An Accidental Death and Dismemberment Insurance Policy?
Your accidental death and dismemberment policy will also state what specific injuries are covered under the policy. Much like the definition of the word “accident”, the definition of the compensable injuries in many accidental death and dismemberment policies are intentionally drafted so that they can only be applied to very specific circumstances and exclude many common significant injuries.
Some common exclusions under policies for accidental death and dismemberment insurance are:
- Injuries specifically excluded in the policy
- Death due to illness
- Death resulting from criminal activity
- Death caused by war or terrorism
- Death caused by suicide
- Death or injury resulting from use of illegal substances
- Death or injury resulting from extreme sports (sky-diving, scuba diving, racing, etc.)
- Death or injury not resulting from an “accident”
- Death or injury resulting from a specifically excluded type of accident
- Self-inflicted injury
This list is not exhaustive and what is or isn’t covered under your accidental death & dismemberment insurance coverage will depend on the specific wording of your policy.
Common Reasons Accidental Death & Dismemberment Claims Are Denied
There can be a number of reasons why an insurance company might deny a claim for insurance benefits under a policy of accidental death & dismemberment insurance, however the most common reasons such claims are denied are:
- a misrepresentation in the application for insurance coverage
- a fraudulent representation in the application for insurance coverage
- a failure to adhere to the specific terms of your insurance policy
- the death or injury occurred due to an excluded cause.
- the policy has lapsed due to failure to pay premiums
Just because an insurance adjuster says your claim is denied doesn’t mean that is the end of the road. If you believe your accidental death & dismemberment claim was denied wrongly an experienced insurance denial lawyer can help make your insurance company pay you’re the benefits you are owed.
Accidental Death & Dismemberment Claims & Timelines
The purpose of accidental death and dismemberment insurance is to provide peace of mind and financial assistance when serious injuries or death occur. To have your accidental death and dismemberment claim denied due to a strict reading of the policy’s wording can feel like you are being betrayed by your insurance company. An experienced insurance denial lawyer can review your medical documentation and help interpret the policy in your favour and make your insurance company the accidental death and dismemberment benefits you are entitled to.
There is a time limit in which you need to act if you want to enforce your entitlement to accidental death and dismemberment benefits. If you do not act in time you can be barred by statute from fighting for your benefits in Court. These time limits can vary depending on the terms of your policy.
If you’ve been wrongfully denied your accidental death and dismemberment benefits, contact the lawyers at Taylor & Blair LLP today for a free consultation.