AD&D insurance is specifically for accident-related deaths. The key to making a successful claim is proving that the insured’s death or injury was directly caused by an accident covered under the policy.
For example, let’s say the insured suffered a heart attack while skydiving, which led to their death. Even though the heart attack triggered the fatal event, the insurance company may deny the claim because the heart attack is considered a natural cause of death. In such cases, the death would fall under a typical life insurance policy, rather than AD&D insurance.
Here are a few examples of accidental deaths that would typically be covered by AD&D insurance:
Car accidents or accidents involving other vehicles, including buses and public transportation.
Fire-related deaths, including asphyxiation, burns, or falling objects caused by fire.
Drowning in a pool, lake, or other bodies of water.
Falls, including slip-and-fall accidents at home or in public spaces.
Poisoning, whether accidental ingestion of harmful substances or exposure to toxins.
Murder, including deaths caused by shootings or stabbings (whether intentional or accidental).
Industrial accidents, such as explosions, equipment failures, or accidents in mining and manufacturing industries.
Pedestrian accidents and accidents involving water, train, or air transport.
For the beneficiary to receive the accidental death benefit, the death must typically occur within 365 days of the accident. After this period, insurers may argue that the death was not caused by the accident but rather by some other factor, thus invalidating the claim.
Exclusions in AD&D Insurance Policies: What Is Not Covered?
Accidental death policies contain various exclusions, or clauses that specify circumstances in which the policy will not pay out. Common exclusions in AD&D insurance policies include:
Suicide or self-inflicted injury, regardless of mental state at the time.
Death caused by mental or psychological disorders, including the aggravation of these conditions.
Participation in acts of war, whether declared or not, or involvement in riots or civil disturbances.
Deaths occurring while in military service or on active duty with any nation’s armed forces.
Fatalities occurring during certain aviation activities, including when the insured is a pilot, crew member, student pilot, or a flight instructor.
Drug overdoses, especially from illegal substances (e.g., opioids, amphetamines) or from prescription drugs that were abused.
Deaths caused by criminal activity, including fatalities resulting from engaging in a crime.
Alcohol-related deaths, including deaths resulting from driving under the influence or fatalities caused by legal intoxication.
Medical procedures, such as surgeries or rehabilitation following surgery, where the death is caused by complications.
Medical malpractice or negligence during treatment.
Fatalities resulting from high-risk activities, such as professional sports, car racing, bungee jumping, skydiving, and scuba diving.
Deaths caused by autoerotic asphyxiation or similar dangerous practices.
While many of these exclusions are typical, insurers may still wrongfully reject a claim even if the insured’s death falls under one of these categories. In some cases, a policyholder’s death may fall into a gray area where the insurance company improperly denies a claim.
What to Do If Your Accidental Death Claim Is Denied
If your accidental death insurance claim has been denied, it can be incredibly frustrating, especially when the death was clearly the result of an accident. However, it’s important to understand that insurers are not always correct in their denial decisions. If you feel that the insurer’s rejection is unjust, it may be worth challenging the decision.
Here’s what you can do if your AD&D insurance claim is denied:
Review the Denial Letter: Understand the specific reasons why your claim was denied. The letter should include details about the policy’s exclusions or other factors considered in the decision.
Examine Your Policy: Make sure you understand the terms of your AD&D insurance policy. Double-check any exclusions that the insurer may have cited and ensure the circumstances of the death align with the coverage terms.
Consult a Life Insurance Lawyer: An experienced life insurance attorney can help you assess the denial and determine whether the rejection was legitimate. The attorney can help you gather the necessary evidence and file an appeal if necessary.
Challenge the Denial: If there’s a strong case for why the insurer should pay the claim, your lawyer can help you challenge the denial through negotiations or legal action.
Having legal representation during a dispute over an accidental death claim can increase your chances of receiving the benefits you are entitled to, ensuring that your loved ones are not left in financial hardship.
FAQ: Frequently Asked Questions About Accidental Death & Dismemberment Insurance
1. What types of deaths are covered under AD&D insurance?
AD&D insurance covers deaths that result from accidents, such as car accidents, falls, drownings, industrial mishaps, and other unexpected events that lead to accidental injury or death.
2. What is not covered by AD&D insurance?
Exclusions typically include deaths caused by suicide, self-inflicted injuries, illegal drugs, alcohol intoxication, criminal activity, high-risk activities, and medical negligence.
3. Can AD&D insurance be denied if the death occurs more than a year after the accident?
Yes, most AD&D policies require the insured’s death to occur within 365 days of the accident. If the death occurs after this period, the insurer may argue that the death was unrelated to the accident.
4. What should I do if my AD&D insurance claim is denied?
If your claim is denied, carefully review the denial letter and policy terms. You may want to consult with a life insurance lawyer to understand your options for disputing the denial and ensuring you receive the benefits you’re entitled to.
5. Can a life insurance lawyer help with accidental death claim denials?
Yes, a lawyer specializing in life insurance claims can help review your policy, gather evidence, and challenge the insurer’s decision if the claim was wrongfully denied.
6. Is accidental death insurance the same as life insurance?
No, while life insurance covers a range of death causes, AD&D insurance specifically covers deaths caused by accidents. Life insurance provides more comprehensive coverage, including deaths from natural causes.