Similar to a standard life insurance policy, there are unfortunate circumstances where claims on an Accidental Death & Dismemberment (AD&D) policy do get denied. For those of you that may not be regular readers of the blog, an AD&D policy is a somewhat limited form of life insurance. Without going too heavily in to the details involved in an AD&D policy, the basic idea for such a policy is that the insured is covered in the event that an accident occurs that may have cut the insured life’s short or dismembered the insured’s body. The premise for such a policy is that only an accident would leave the insured unprepared financially and is there to provide for the insured or his/her beneficiaries. While an AD&D policy may be different than a standard life insurance policy, it is similar in some ways as well.
One way that AD&D insurance is similar to a standard life insurance policy is that individuals are required to file a claim to attempt to collect a payout on this policy. During this process, individuals will receive notification of a claims determination in the form of an approval, delay or denial. Worst case scenario is a denial and many are left wondering what to do next when this occurs. The most common resolution is for denied claims to go through an appeals process with the insurance provider itself. Luckily for our readers, we are experienced in these circumstances and are here to help guide you along. In this article, we plan to break down the general guidelines for how to appeal a denied claim.
Reasons for a Denial
As with any insurance policy, there are exceptions to the coverage the consumer has paid. Essentially, excuses for the insurance provider to get out of having to pay the insured for damages recently suffered. When it comes to AD&D insurance, the name of the policy type is relatively self explanatory as to what incidents you can expect to have covered. Under this type of policy, there are several reasons for a denial by the insurance provider. Some examples of a denied AD&D claim are as follows:
- Intentional injuries (self-inflicted);
- Illnesses; and
- Injuries while committing a felony or being legally intoxicated;
There are other reasons for denial but these are just some of the more common reasons. For individuals in certain professions, the reasons for denial are extended even more. To get exact exceptions to your policy, you should be able to ask specifics from your insurance provider.
If you feel like your AD&D claim has been wrongfully rejected, one option may be to go through the appeals process with the insurance provider of the policy. This process is often drawn out, but can be the most cost effective means of contesting a denied claim. You will often need to file a form to start the process and the provider will review and investigate the matter. From there, they may choose to reverse the denial decision, but most likely they will stick with it. The truth in the situation is that they are not likely to favor the side of the beneficiary. This is due to the fact that they want to keep the money in their pockets, instead of yours. While they do have an appeals process option, it is hard to rely on a favorable outcome.
Once you have an understanding of why your claim was denied, you do have the option of getting a life insurance law firm if you want to get paid. Our life insurance attorneys resolve these claim almost all of the time.