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After the sudden death of a loved one, the last thing you want to have to worry about is insurance claims, especially the headache that can come with accidental death and dismemberment (AD&D) claim denial. However, that’s often the reality that many beneficiaries have to deal with when a spouse, child, or parent passes away suddenly. 

An accidental death claim denial can have catastrophic effects on beneficiaries, leaving them in a precarious financial situation. In this month’s blog, we’re discussing why an accidental death claim may be denied and what you should do in the aftermath.

Understanding the Reason for an Accidental Death Claim Denial

It’s important to understand that insurance companies aren’t keen on accepting claims. That means they’re out of the money they have to pay the beneficiaries, and insurance companies are companies, after all. There are several common reasons why an accidental death claim may be denied so insurance doesn’t have to pay out.

Policy Exclusions 

Accidental death and dismemberment insurance policies list exclusions that would give valid legal qualifications for the insurance company to deny your claim. This usually includes anything pertaining to an overdose, including if the decedent died in a car wreck while under the influence of alcohol. Policy exclusions typically also include dangerous or reckless activities or hobbies or if the policyholder died while committing a crime. Additionally, the claim may be denied if your loved one commits suicide, as this is a common exclusion that policies include.

Furthermore, if the insurance was offered through the decedent’s employer, the claim may be governed by ERISA (Employee Retirement Income Security Act). This would make the claim subject to employee benefits governed by federal law, which is its own set of rules and regulations.

Missed Deadlines

Missed deadlines encompass policy lapses and waiting too long to file an appeal if your initial claim is denied. When a policy lapses, the policyholder fails to pay the premium on time. If the policy lapses and they don’t catch up on their payments before their death, the insurance company will deny the claim. Additionally, if your initial accidental death claim is denied, you have a limited amount of time to file an appeal to challenge the denial. This should be specified in the denial letter the beneficiary receives explaining the reason for the claim denial.

Lack of Documentation

AD&D claims are also denied due to a lack of documentation. If the insurance company feels they don’t have enough medical documentation to rule the death an accident, they will deny the claim. Therefore, it is essential to gather all of the insurance policy documentation in addition to any hospital, medical, or autopsy documentation. This includes the death certificate and any accident or police reports.

Reviewing the Denial Letter

When an AD&D claim is denied, the insurance company will send a letter to the beneficiary explaining why the claim is denied. It’s essential to review every detail of this letter to understand precisely why the claim is denied. If the letter seems vague or lacks a definitive explanation, the beneficiary can call the insurance company directly for clarification. Often, these insurance companies hope the beneficiary is so overwhelmed and overcome with grief that the denial letter alone will suffice permanently or long enough for the appeal period to pass.

Consider an Appeal and Seek Legal Guidance

You don’t have to wait for a denial letter to seek legal advice. Being proactive can often save beneficiaries time and money during this difficult time. Contacting an attorney who specializes in accidental death claim denials, like us here at Sinclair Law Firm, after your loved one passes and before filing your AD&D claim can help you understand all the details of the policy and what decision the insurance company is likely to take.
This way, if your accidental death claim is denied, we’re already familiar with your case and equipped to immediately file an appeal and get you the money you deserve. Having an experienced AD&D claim attorney on your side during an appeal greatly enhances your chances of a successful court ruling. Contact us today for a free claim review! We’ll help you fight for what you and your family deserve.