The accidental death and dismemberment lawyers at The Garner Firm help beneficiaries nationwide fight back after an insurer wrongfully denies an AD&D claim. Employers commonly include Accidental Death and Dismemberment (“AD&D”) coverage as a supplemental benefit within a group life insurance plan. The U.S. Department of Labor regulates most employer-sponsored AD&D plans under the Employee Retirement Income Security Act of 1974 (“ERISA“). Federal, state, and local government plans fall outside ERISA, as do plans offered by certain religiously affiliated employers.
If the insurance company denies your accidental death and dismemberment claim, do not assume the insurer’s explanation for the denial is valid.
What Counts as an “Accidental” Death or Dismemberment?
Many people assume a beneficiary automatically qualifies for AD&D benefits whenever a covered individual dies. That is often not true. The death or injury must usually result from an “accident” as the policy narrowly defines that term. Insurance companies frequently deny AD&D claims by arguing the death was not accidental, or by improperly applying a policy exclusion. These disputes commonly arise in cases involving:
- Certain motor vehicle and motorcycle accidents
- Inadvertent fatal asphyxiation
- Accidental overdoses involving prescription medications
- Drowning or other unwitnessed deaths
- Other instances of unexplained or unattended death
Common Reasons Insurers Deny AD&D Claims
AD&D policies typically contain a lengthy list of exclusions. Insurers use these exclusions to justify denying otherwise valid claims. The most frequently litigated exclusions include intoxication or drug use, “sickness or disease,” self-inflicted injury, and injuries sustained during illegal activity. Insurers also dispute whether the injury was the sole and direct cause of death, or claim the beneficiary missed a filing deadline. An experienced accidental death and dismemberment attorney can evaluate whether the insurer properly applied an exclusion to your loved one’s death.
ERISA Appeal Deadlines and the Mandatory Appeal Process
ERISA gives you a relatively short window to appeal a denied AD&D claim. Every ERISA AD&D plan requires you to exhaust this mandatory internal appeal before filing suit in court. Missing the deadline, or submitting an incomplete appeal, can permanently bar you from recovering benefits. An experienced ERISA accidental death and dismemberment attorney can explain this process, flag the potential issues with your claim, and help you build a strong administrative record for your appeal.
How an Accidental Death and Dismemberment Lawyer Helps
Consult an experienced ERISA accidental death and dismemberment attorney before you accept an insurer’s denial. An experienced accidental death and dismemberment attorney will review the facts of the insured’s death, review your policy language, and explain your rights. The Garner Firm’s attorneys have recovered significant benefits for beneficiaries in ERISA life insurance and AD&D disputes. We regularly litigate against major insurers.
Frequently Asked Questions About AD&D Claims
Is AD&D the same as life insurance?
No. AD&D pays out only when a death or dismemberment results from a qualifying accident. Basic life insurance pays out regardless of the cause of death, subject to standard exclusions like suicide within the contestability period.
How long do I have to appeal a denied ERISA AD&D claim?
Most ERISA-governed AD&D plans set an appeal window of 60 or 180 days from the denial letter. Courts strictly enforce this deadline, and your administrative appeal record often decides the outcome of any later lawsuit. Contact an ERISA accidental death and dismemberment lawyer as soon as you receive a denial.
Can I sue my insurer directly if my AD&D claim is denied?
If ERISA governs your plan, you must first exhaust the plan’s internal appeal process before filing suit, and courts generally limit your remedies to the benefits owed under the plan. If your policy falls outside ERISA, you may have additional remedies, including bad-faith claims, depending on your state’s insurance law.
What should I do if my AD&D claim was denied?
Do not assume the denial is correct or final. Request a complete copy of your claim file and the governing plan documents, note your appeal deadline, and contact an experienced accidental death and dismemberment attorney to evaluate the insurer’s stated reasons before you respond.
The Garner Firm’s Attorneys Can Help With Your Accidental Death and Dismemberment Insurance Claim
Adam H. Garner is an experienced accidental death and dismemberment insurance attorney and who formerly chaired the ABA Tort Trial & Insurance Practice Section’s Health & Disability Insurance Committee. If you have questions about your accidental death and dismemberment insurance claim, contact The Garner Firm today for a free case review.
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