Accidental death insurance policies generally cover deaths resulting from accidents, but they come with specific exclusions and requirements. If you need a Wisconsin life insurance denial attorney call us. Below are the most common reasons why an accidental death claim might be denied:
1. Death Was Not an Accident
The most common reason for a claim denial is the insurance company’s determination that the death was not accidental. For example, if the policyholder dies from natural causes such as a heart attack or stroke, the insurance company may argue that the death was not caused by an accident, and therefore the claim will not be paid out.
Insurance policies typically define accidents as unintentional, unexpected events that result in bodily injury or death. Deaths caused by illness, diseases, or natural causes are generally not covered under an accidental death insurance policy. It’s important to check your policy's terms to ensure that the cause of death qualifies as an "accident" under the policy.
2. Failure to Follow Proper Claim Filing Procedures
Another frequent reason for claim denial is failure to follow the proper procedures for filing the claim. Insurance companies require specific documents and forms to process claims, such as:
A death certificate
An accident report (such as a police report or accident investigation report)
Any medical records relevant to the death
If any of these documents are missing or incomplete, the insurance company may delay or deny the claim. It’s critical to ensure that you submit all required documentation accurately and on time. To avoid errors, consider consulting with a professional who can guide you through the process.
3. Deliberate Endangerment
In cases where the insurance company believes that the death was caused by deliberate endangerment, the claim may be denied. If the policyholder was engaged in risky activities that led to their death, the insurer may argue that the death was avoidable.
For example, deaths occurring while participating in dangerous activities like skydiving, bungee jumping, or driving under the influence of alcohol may lead to a denial. These activities are often seen as high-risk, and many insurance policies have exclusions for deaths resulting from such activities. Insurance companies may argue that the policyholder was negligent or acted recklessly, thus voiding the claim.
4. Non-Compliance with Policy Terms
If the policyholder did not comply with the terms of the life insurance policy, such as failing to disclose relevant information or failing to pay premiums, the insurer may deny the claim. For example, if the policyholder had undiagnosed medical conditions or had made material misrepresentations on the application, the insurer may argue that the policy was void due to fraud or non-disclosure.
It’s essential to keep in mind that life insurance companies may investigate the circumstances surrounding the policyholder’s death thoroughly. If any discrepancies or inconsistencies are found, the insurer may determine that the claim is invalid.
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