ERISA • Employment Law

What to do if Your Accidental Death and Dismemberment Benefits Claim is Denied

01 Oct 2019

You can purchase an accidental death and dismemberment policy, known as an AD&D policy, as an addendum to a life insurance policy. These are also commonly included as a supplemental or secondary benefit with employer-sponsored life insurance benefit plans. In most situations, the benefit plan is regulated by ERISA, the Employee Retirement Income Security Act of 1974. ERISA only regulates private sector employee benefit plans—it does not cover any benefits employees receive from any federal, state, or local governments.

Because there is often a lack of understanding of how AD&D benefits work, families assume that they are automatically entitled to these benefits when the employee passes away. In some cases, accidental death and dismemberment benefits would not be applicable because the individual in question did not die in an accident. However, there are numerous other cases in which the employee did die accidentally, but the insurance company claims it was not an accident or tries to inappropriately apply certain policy exclusions. 

No matter whether you are the covered employee or a member of their family, it is important to understand how AD&D benefits work. If you have a loved one who passed away due to an accident and the insurance company is denying the claim, it is imperative to speak with a Pennsylvania accidental death and dismemberment benefits attorney right away.

Importance of Understanding what an AD&D Policy Covers

The benefits provided under an AD&D policy are designed to pay out if your loved one dies in some type of accident. A common example is a car accident. If you were severely incapacitated in the accident, like losing a limb, you also could potentially receive benefits under your own AD&D policy. 

Because the policy is confusing and insurance companies are looking for any way to reduce their payout or deny a claim entirely, there are numerous exclusions and policy provisions in place to limit their exposure towards AD&D benefits. For example, maybe you get into an accident and lose your leg, but you still live for another six months. Depending on the policy language, your loved ones may not receive the full death benefit payout as the insurance company only pays a death benefit if you pass away within a certain timeframe.

Also, if you are engaged in high-risk behavior and you die accidentally, they may deny the claim entirely. Examples of high-risk behavior include skydiving or driving while under the influence of alcohol, suicide or attempted suicide, bungee jumping, drag racing, etc.

Appealing a Denial of AD&D Benefits

If you are appealing the denial of an AD&D benefits policy and it is covered under ERISA, you only have a limited time to file the appeal. In addition, there will be a specific mandated appeal process you must go through prior to seeking any type of relief in court. This is where the experience of an accidental death and dismemberment benefits attorney is important. Your attorney can explain the appeals process and help you seek relief in court.

Contact an AD&D Benefits Lawyer Today

If you have questions or need assistance with appealing a denial for accidental death and dismemberment benefits, do not attempt to go at it alone. Contact The Garner Firm today to schedule an initial consultation.

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Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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