Our life insurance lawyers handle various cases of life insurance claim delays and denials. Throughout years of working with beneficiaries whose life insurance claims have been denied, we have seen many different reasons why insurance companies may deny a claim. Here, we will describe some common reasons why an insurance company may deny an accidental death claim.
Often, an accidental death policy states that in order for the beneficiary to receive benefits, the insured's death or the loss of a limb or eyesight must occur within a certain time frame after the accident, usually within three months. In addition, the insured's death must be a direct result of the injuries he or she sustained in the accident. If a policyholder dies and meets the criteria, the policy would pay the principal, or full, amount. Loss of limbs or eyesight cases are paid on a so-called scheduled basis, meaning a portion of the principal amount.
Other circumstances connected with an accident or the death could affect a beneficiary's benefits. Exclusions in AD&D policies depend on the insurance company, so different carriers will have different exclusions. For example, some insurance companies cover such dangerous activities as skydiving and mountain climbing while others do not. Events such as dismemberment due to a suicide attempt would fall under life insurance and would be an exclusion; it would not fall under an accidental death policy.
For example, if a person commits suicide or attempts to hurt himself on purpose, the AD&D policy would not pay out. If the accident or your death is caused by a war, the AD&D policy would not pay out either.
The policy would not pay out if the death or loss is caused by physical or mental illness, or if an insured dies during surgery. Many AD&D polices state that if a bacterial infection, drug overdose or a hernia contributes to the death or an accident , it would not be covered under AD&D.
If an insured has a heart attack while driving and crashes his/her car, their beneficiary would not receive any payment from the AD&D policy. But if the deceased has standard life insurance, beneficiary would receive the death benefit.
The Most Common AD&D Exclusions
- Accidental death and dismemberment benefits will not be paid if the death or dismemberment results from:
- Physical or mental illness
- External wound
- Death from any fighting or war
- Suicide or attempted suicide
- Intentionally injuring yourself
- Taking drugs which are illegal
- Driunk driving
There may be other accidental death exclusions. As we stated before, each insurance company has different policy provisions. If your claim for accidental death benefits has been denied, please call us for help.