We recently secured a full two hundred thousand dollar benefit for a family after their accidental death and dismemberment claim was denied. The insurer pointed to a trace amount of alcohol in the decedent’s system and argued that an exclusion applied. By presenting accident reconstruction evidence and expert toxicology testimony we proved that the crash would have been fatal regardless and that the policy definition of accidental death did not bar payment. Faced with clear policy language and expert reports the carrier reversed course and paid the full benefit. If you have an AD&D denial in Utah call us.
How We Overcame Insurer Tactics
In this matter the insurer relied on overly broad interpretations of policy exclusions and vague definitions of accidental death. We obtained detailed scene analysis showing that a single vehicle impact alone caused the fatal injuries and that the small alcohol reading was unrelated. When the carrier refused to reconsider we deposed their own medical reviewer and exposed inconsistencies in how their policy language was applied. That combination of technical expertise and thorough discovery compelled the insurer to honor the coverage.
Real Life Obstacles in AD&D Claims
Too often families encounter denials based on minor or irrelevant facts. For example a widow in Ohio saw her claim refused after the insurer learned of a remote history of epilepsy despite proof that no seizure occurred at the time of a fatal fall. In another case a hang glider pilot’s estate faced denial because the insurer claimed all gliding activities were excluded even though the policy only barred professional competitions. We also defeated a denial where a DIY skier’s death was denied for lack of helmet use by presenting ski patrol rules confirming gear was optional on that slope. And when a family in Texas missed the thirty day reporting window due to a winter storm we pointed to a catastrophe extension clause that allowed extra time.
Some carriers deny claims by questioning intent or circumstances. An insurer in Florida treated a drowning on private property as a criminal trespass case until we showed that trespass alone was not disqualifying. In a separate matter a beneficiary’s late statement led to denial until we rescheduled the session and provided missing documents. Insufficient evidence denials can be overcome by gathering police reports medical examiner records and expert analysis as we did for a motorcycle crash that was initially ruled inconclusive.
Why You Should Challenge a Denial
Insurers depend on confusion and grief to delay or avoid payment. When families accept a denial they lose leverage to question vague definitions or overly broad exclusions. By partnering with seasoned attorneys you gain access to experts in accident reconstruction toxicology and medical causation who can dismantle an insurer’s arguments piece by piece. Every denial based on a minor technicality can be an opportunity to enforce the clear terms of the policy.