ERISA • Employment Law

What to Do After Your Spouse’s Accidental Death

24 Mar 2020

Many people have accidental death and dismemberment coverage through their employer under the Employee Retirement Income Security Act of 1974 (ERISA). This coverage can be critical if you learn that your spouse passed away due to an accidental injury, as it can provide benefits to offset the losses you can experience due to sudden death. However, benefits are not automatic, and you must take certain steps to protect your rights as the beneficiary of the accidental death policy and receive the benefits you deserve. 

If you are in this situation, you might have little to no experience with this type of insurance claim. Insurance companies can be difficult – even when there is a tragic loss involved. It can be wise to consult with a Philadelphia accidental death insurance lawyer who can guide you through the process. 

While each situation has different circumstances, the following are some general steps that might follow a spouse’s accidental death.

Filing the Initial Claim

The insurance company must be properly notified of the accidental death and the request for benefits, and you do so by preparing and filing a claim. The claim process can vary depending on the insurance provider, though the policy should have clear instructions on how to file your claim. 

The Insurance Investigation

This type of insurance company will only pay out on claims stemming from accidental death, so it will conduct an investigation to confirm the cause of death. The adjuster might require any records of documents relevant to the death, including police reports, toxicology reports, medical examiner reports, medical records of treatment prior to the death, and more. You want to submit all requested documents promptly because the sooner the adjuster confirms the accidental death, the sooner you can receive your benefits. Many insurance companies delay payment based on claims they do not have enough information to confirm the accidental cause of death. 

Confirming the Status of Your Claim

Following the investigation period, the insurance company should notify you promptly whether your claim was accepted or denied. If you do not hear from the company, you should check on the status of your claim. If your claim was accepted, payment should not be delayed.

If the insurance company denied your claim, you should determine the exact reason for the denial. It is imperative to contact an attorney at this stage if you have not done so already. Denial is not a final answer, as you have the ability to appeal and even initiate litigation against the insurer if necessary to receive payment on a valid claim. The appeal process is complicated, however, so you want an experienced ERISA litigation attorney advocating for your rights. 

Contact a Philadelphia Accidental Death Claim Attorney for Assistance

Sometimes, the sudden death of a loved one is only made worse by the delay or denial of benefits you deserve under an accidental death policy. If you would like assistance filing a claim or appealing a denial, contact The Garner Firm right away. 

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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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