Life insurance claim denials can be incredibly frustrating, especially when the beneficiary is already grieving a loss. Our life insurance attorneys have worked with numerous clients whose AD&D claims (Accidental Death and Dismemberment) were delayed or denied. While the specifics can vary, there are several common reasons why insurance companies might deny an AD&D claim.
Understanding Accidental Death and Dismemberment Policies
An AD&D policy typically pays out benefits if the insured dies or suffers severe injuries such as the loss of a limb or eyesight due to an accident. However, there are specific conditions that must be met for the beneficiary to receive a payout.
For instance:
The insured’s death must occur within a specific time frame after the accident, often within three months.
The cause of death must be a direct result of the injuries sustained in the accident.
If the insured dies and meets the criteria, the policy pays out the full principal amount. If there is a loss of a limb or eyesight, the benefit is usually paid on a scheduled basis, meaning a portion of the principal amount is paid out.
Common Reasons for AD&D Claim Denials
Insurance companies have their own set of exclusions in AD&D policies, and some of them may surprise beneficiaries. Here are some of the most common reasons for AD&D claim denials:
1. Exclusions Based on Dangerous Activities
Different insurers have varying policies regarding high-risk activities. Some may exclude coverage for accidents related to activities like skydiving, mountain climbing, or other dangerous activities. It is important to review your policy to understand what is excluded.
2. Death or Injury Due to Suicide or Self-Inflicted Injuries
If the insured’s death or injury was the result of suicide or self-harm, AD&D benefits will not be paid. Many AD&D policies exclude coverage if the insured intentionally injures themselves or attempts suicide.
3. War or Combat-Related Deaths
Another common exclusion is war. If the insured’s death is caused by actions related to war, whether it’s a combat death or civil unrest, an AD&D policy may refuse to pay the claim.
4. Death or Injury Caused by Physical or Mental Illness
If the insured suffers from a physical or mental illness that leads to their death or injury, many AD&D policies will not cover it. This is a common reason for claim denials in cases where death was caused by a pre-existing condition rather than an accident.
5. Drug Overdoses or Bacterial Infections
Some AD&D policies exclude claims where the insured’s death is caused by drug overdose, especially if the drug use is illegal, or by a bacterial infection. Policies may also deny claims in cases where a hernia or other non-accidental cause contributed to the death.
6. Driving Under the Influence
If the insured was driving under the influence of drugs or alcohol at the time of the accident, AD&D benefits may be denied. Insurance companies often cite drunk driving as a reason for denial, as it is viewed as a preventable cause of the accident.
7. Death During Surgery
In some cases, AD&D policies do not pay benefits if the insured dies during surgery, even if it was an accident. Since surgery is considered a medical procedure, such deaths may be classified differently from accidents.
8. External Wounds Not Caused by Accidents
If the cause of death was external wounds or injuries that were not directly caused by an accident, the insurer may argue that the claim does not meet the criteria for accidental death benefits.
The Most Common AD&D Exclusions
Death or dismemberment resulting from physical or mental illness
Death from fighting or war
Suicide or attempted suicide
Intentionally injuring yourself
Illegal drug use
Drunk driving
Non-accidental causes of death, such as medical procedures or infections
What to Do If Your AD&D Claim Was Denied
If your AD&D claim was wrongfully denied, it’s essential to take immediate action. Life insurance lawyers can help you navigate the complex process of disputing the denial. We can help you understand the specifics of your AD&D policy and work to get the benefits your loved one is entitled to.
How Our Attorneys Can Help
Our life insurance attorneys specialize in handling claim denials, including AD&D claims. We understand the tactics insurers use to deny valid claims, and we have a proven track record of success in securing fair payouts for our clients.
If your AD&D claim has been denied or delayed, don’t try to handle the situation alone. Contact us for a free consultation, and let us help you understand your legal rights and options. We are committed to ensuring that you receive the benefits you are entitled to. Call if you need life insurance claim help in Maryland