Richard was a successful executive investment banker. On his way home from a business meeting Richard was killed in a head on collision. The other driver crossed the double yellow lines and hit Richard in his lane of travel. His family was devastated. Aside from dealing with the loss of her husband, Joann was worried about how she was going to support their family of 3 young children on her part-time salary without his income. There was some comfort in knowing he had purchased an Accidental Death Insurance Policy through his credit card company as added financial security & protection for his family. Joann filed all of the appropriate paperwork, she was shocked when she received a denial notice from the insurance company. She was frantic because she knew from a friend that she had a small window of time to appeal the denial.
Despite the accident report, the insurance company denied her claim on the grounds that Richard had a blood alcohol level above the legal limit. The insurance company asserted that Richard did not perish in an accident.
Accident is generally defined by the courts as an unexpected and unintended occurrence. The insurance company refused to pay arguing that it was reasonably foreseeable that driving while under the influence of alcohol could lead to death.
Most People Are Confused and Discouraged When Their AD&D Claim Is Denied
They don’t understand how what seems clearly an accident is not viewed as an accident by the insurance company. Therefore, fighting the insurance company may seem daunting as you grieve for your loved one or recover from catastrophic injuries.
Unfortunately, insurance companies often resist paying AD&D claims in a timely manner. The longer they hold on to the money, the more profit they make. They may even deny your claim saying that your loss is not covered.
As the Pennsylvania Supreme Court remarked in:
Brenneman v. St Paul F. & M. Ins. Co., 411, 412-13 Pa. 409 (1963)
“Everyone knows what an accident is until the word comes up in court. Then it becomes a mysterious phenomenon. And, in order to resolve the enigma, witnesses are summoned, experts testify, lawyers argue, treatises are consulted and even when a conclave of twelve world -knowledgeable individuals agree as to whether a certain set of facts made out an accident, the question may not yet be settled and it must be reheard in an appellate court. An accident simply stated, is merely an unanticipated event; it is something which occurs not as the result of natural routine but as the culmination of forces working without design, coordination or plan. And the more disorganized the forces, the more confusedly they operate, the more indiscriminately haphazard the clash and intermingling, the more perfect is the resulting accident.”
You Have a Right to Appeal Your Claim Denial
You have a limited time to file your request for an appeal. For example, most appeal deadlines are only 60-90 days from the time of the denial. If your AD&D claim had been denied don’t delay.
Common Claim Denials Involve
- ALCOHOL EXCLUSIONS
- DRUG EXCLUSIONS
- SINGLE-CAR ACCIDENT WHERE ALCOHOL OR DRUG INDICATIONS ARE PRESENT
- PRE-EXISTING ILLNESS OR DISEASE EXCLUSIONS
- PRIVATE AIRCRAFT ECLUSIONS
- WAR EXCLUSIONS
Other reasons for denied claims that could be incorrect or unfair include:
- DENYING THE CLAIM BECAUSE THE ACCIDENT DIDN’T “DIRECTLY CAUSE” THE DEATH OR DISMEMBERMENT
Our Goal Is the Same as Yours - Prompt Payment of Your Claim
When your insurance company reviews a detailed accidental death claim appeal supported with solid evidence substantiating your death benefit claim, the insurer is more likely to approve your claim. We guide you through the process, in addition to helping you every step of the way.
If you feel your accidental death insurance death benefit claim was unfairly denied, Mr. Feigenbaum will examine your claim and provide you with the advice you need.
To Learn More About Your Accidental Death & Dismemberment Claim
To talk with a lawyer you can trust about either your insurance or employee benefits claim or appealing or pursuing litigation in court, contact us at www.erisaattorneys.com, or call at 617-357-9700 or toll-free at 866-396-9722. Your initial consultation is free.