How to Handle Accidental Death Claims

by | Feb 19, 2018 | Insurance Laws | 0 comments

Life insurance typically carries an accidental death policy, which is invoked when the insured individual is killed in an accident. A regular insurance policy or separate policy can include accidental death benefits.

What Does Accidental Death and Dismemberment Insurance Cover?

Coverage for accidental death and dismemberment (ADD) gives protection to a beneficiary if the insured individual dies in an accident or loses a limb or the ability to see or hear following an accident.

Life Insurance and Accidental Death

Generally, life insurance policies cover accidental death and deaths stemming from natural causes. Policies including accidental death tend to offer more benefits when the insured dies in an accident. If the individual had a regular life insurance policy as well as one for accidental death and dismemberment and died because an accident, the insurance company would have to pay for both claims.

When Does ADD Coverage Pay?

Insurance companies are required to pay accidental death and dismemberment claims when they have all the necessary records proving a death was accidental. However, an insurance company must first perform an investigation. It will explore medical examiner reports, police reports, toxicology reports, and anything else that’s pertinent. After all documentation is submitted and liability is determined, the company is required to quickly pay the claim.

At the same time, many ADD claims are delayed for months or years because investigations can take a long time. There must be sufficient evidence proving the death was accidental. However, most claims are paid within 30 to 60 days after a death.

How Accidental Death Insurance Works

If a person was insured and died from an accident, his beneficiary is required to file a claim with the insurance company. The insurance company then contacts the beneficiary to request documents showing the death was accidental and not natural. Although a death certificate is proof, insurance companies generally require more than that, which is why an investigation is conducted.

Sometimes, insurance companies deny claims because the beneficiary can’t prove the death was accidental. Other denials are because of certain ADD exclusions. An exclusion is included in a contract and describes situations in which benefits are not payable. A policy wouldn’t pay ADD benefits if death included the following:

  • Suicide
  • Illness
  • War
  • Injury from time in the armed forces
  • Injury sustained while on an aircraft as a pilot, student pilot, flight instructor, examiner, or crew member
  • Injury from voluntarily taking drugs without a prescription
  • Injury sustained while attempting to commit a felony
  • Injury from legal intoxication from alcohol
  • Injury sustained when driving while intoxicated from alcohol

Appealing a Denied ADD Claim

A life insurance attorney can help a beneficiary in handling denied ADD claims. The following types of cases can be explored by an attorney:

  • Insured’s death wasn’t accidental
  • Policy exclusion applied and canceled coverage
  • Insured was intoxicated at time of death
  • Insured took prescription medications not prescribed by a doctor
  • Insured died during a medical procedure or during or after surgery
  • Insured committed a felony at the time of death
  • Insured died of a prescription drug overdose
  • Insured died from illness
  • Insured died in an accident but death was due to illness
  • Insured died from medical malpractice
  • Cause of death is unknown
  • Insured disappeared and was pronounced dead as a result
  • Insured died from autoerotic asphyxiation
  • Insured was poisoned
  • Insured was murdered
  • Insured died after involuntarily ingesting illegal drugs

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