Understanding Accidental Death & Dismemberment Insurance: Common Ways Insurance Companies Attempt to Deny Claims

Accidental Death and Dismemberment insurance (AD&D) is a specialized type of coverage that provides financial protection in the unfortunate event of accidental death or severe injury. While it may seem straightforward, navigating the complexities of AD&D insurance can be challenging, especially as a beneficiary when filing a claim. In this blog post, we will delve into the basics of AD&D insurance and explore the most common reasons why claims are denied.

What is Accidental Death and Dismemberment Insurance?

AD&D insurance is designed to offer a safety net for policyholders and/or their loved one(s) in cases of accidental death or severe injuries resulting in dismemberment. Unlike traditional life insurance, AD&D specifically covers sudden, unforeseen, and unintentional events and is subject to various limitations and exclusions. The coverage can extend to a range of accidents, including but not limited to car accidents, falls, and other unforeseen incidents. In the case of dismemberment, the policyholder receives a benefit based on the severity of the injury, such as the loss of a limb or sight.

Common Reasons for AD&D Claim Denials

1. Exclusions and Limitations:
   AD&D policies often come with a list of exclusions and limitations that define the scope of coverage. Typical exclusions may include deaths or injuries resulting from pre-existing conditions, self-inflicted harm, or activities deemed high-risk.
2. Failure to Meet Criteria for Dismemberment:
   For dismemberment claims, insurers typically have specific criteria that must be met to qualify for benefits. The claim may be denied if the injury does not meet the predefined conditions outlined in the policy.
3. Delayed Reporting and/or Appealing:
   Timeliness is critical when it comes to filing and appealing an AD&D claim. Insurance policies and/or laws often have strict deadlines for reporting claims and appealing denials.
4. Misrepresentation or Fraud:
   Providing inaccurate information or attempting to defraud the insurance company can lead to claim denials. Insurers thoroughly investigate claims, and any discrepancies between the reported incident and the actual circumstances can result in the rejection of the claim.

AD&D insurance can be a valuable financial safety net for you or your loved ones in the event of accidental death or dismemberment. While it provides more limited coverage than traditional life insurance, it is not uncommon for insurance companies to try and deny claims by either attempting to narrow its definition of “accident” or expanding the scope of an exclusion.

Please remember, a “No” from the insurance company isn’t the end of the claim – it’s often just the beginning. In the case of a denied claim, the insurance company hopes you don’t hire a skilled plaintiff’s insurance lawyer to navigate the appeals process and pursue the rightful compensation. At Life Legal Services, all we do is fight for beneficiaries of life insurance, AD&D insurance, and critical illness insurance policies against insurance companies that place profits over claim payments. Using our firm to fight for the benefits you are owed will cost you nothing up front, nothing throughout our representation, and nothing at the end unless we are successful. When we take on your case, we are committing our skills, experience, and resources to fight on your behalf. Contact Life Legal Services today to set up your free, no-obligation consultation and start fighting back for the benefits you are owed.