Your family may be protected from the tragedy of an unexpected death or catastrophic injury by an accidental death and dismemberment (AD&D) insurance policy. 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 the policy does not cover your loss. If you are the beneficiary of an AD&D policy and need help getting the insurer to pay your claim, let Accidental death claims attorney Jonathan M. Feigenbaum, Esquire, stand up to the insurance company for you.

What Do Accidental Death and Dismemberment Policies Cover?

Accidental death and dismemberment insurance policies are a form of limited life insurance. These policies pay the beneficiary a lump sum when the insured dies or suffers dismemberment in an accident.

You may be covered by AD&D insurance as a rider to your (or your late loved one’s) life insurance policy (the so-called “double indemnity” provision). You may have coverage through a separate policy purchased from a life insurance company, bank, credit union, or credit card company. Or you could have AD&D insurance through your or your loved one’s employment. Some employer provided policies cover dependents of the employee in addition to the employee. Others cover only accidents occurring while the employee is traveling on the employer’s business.

Accidental Death or Death by Accidental Means

An accidental death is commonly defined as a death occurring as a result of other than natural causes. These policies typically pay off. That is, provided that the insured did not intend to die and the coverage does not expressly exclude the cause of death. For example, most accidental death policies cover death by traffic accident, homicide, fall, industrial accident, and drowning. The death must have occurred within a certain period of time after the accident. (The time period is often 90 days, but sometimes as long as one year).

Difficult coverage issues arise when the death has more than one cause and one is accidental and one is not; for example, if a person hospitalized with terminal cancer is placed on a ventilator to breathe, and the ventilator malfunctions and the person dies.

Some policies provide coverage for death by accidental means, rather than an accidental death. A death is accidental when the deceased person didn’t intend to die, even though he or she intended to do the act that caused the death. A death is by accidental means when the person didn’t intend to do the act that caused the death. For example, the U.S. Supreme Court ruled in one case that a man who died of sun stroke while playing golf may have died accidentally, but did not die by accidental means. This is because he deliberately stood in the sun while golfing.

Accidental Death Exclusions

Exclusions are situations specifically listed in the policy that the policy does not cover. Typical accidental death and dismemberment exclusions include:

  • Suicide.
  • War or accident while the insured is in the military.
  • Flying a plane or working as a flight crew member.
  • Sickness or disease including surgical or medical treatment.
  • Racing in a car, whether as the driver or a passenger.
  • Driving an automobile for compensation or hire.
  • An accident occurring while the insured is intoxicated or under the influence of a narcotic, unless administered on the advice of a physician and without warning against driving.

Dismemberment

Dismemberment is a loss of the use of a “member,” defined as a limb (arm, hand, leg, etc.) or special sense (vision, hearing, speech), or paralysis. Benefits are usually available in accordance with a schedule in the policy. To get full benefits, many dismemberment policies require the loss of use of two limbs or sight in both eyes or paralysis in all four limbs. Partial benefits are available for lesser losses, such as loss of a single limb or vision in one eye.

Call an Experienced Accidental Death Claims Attorney

At the law office of Jonathan M. Feigenbaum, Esquire, our Accidental death claims attorney, provides highly skilled help to people who have suffered dismemberment as well as those who have lost loved ones as the result of an accident. For assistance with your accidental death and dismemberment claim, contact us at 617-357-9700 or toll free at 866-396-9722.