Accidental death and dismemberment policies are intended to provide benefits when an unexpected injury causes death or serious bodily loss. However, insurers sometimes deny AD&D claims when an infection develops after the original accident. The insurer may argue that the infection, rather than the accident itself, caused the death.
These cases often become complex because the accident clearly occurred, yet the insurer claims that the medical complication breaks the chain of accidental causation.
Attorney Christian Lassen represents beneficiaries nationwide in disputes involving denied accidental death and dismemberment claims. When you are facing a denied AD&D claim we are here for you. Look at our Denied AD&D Claim Fact Sheet for more information.
How Infections Can Develop After an Accident
Infections sometimes arise as a direct consequence of an accidental injury. A wound, fracture, or surgical procedure related to the accident may allow bacteria to enter the body. In some situations, the infection becomes severe and ultimately leads to death.
Common scenarios include:
Infection following traumatic wounds
Sepsis after an accident related surgery
Infection from a contaminated injury site
Complications following fractures or internal injuries
Although the infection develops later, the original accident may have triggered the chain of events that led to the fatal outcome.
Why Insurers Deny AD&D Claims in Infection Cases
Insurance companies sometimes deny these claims by arguing that the infection represents a medical condition separate from the accident. According to the insurer, the policy only covers death caused directly by accidental injury.
Example:
The insured suffers a serious cut during an accident and later develops a severe infection. The insurer claims the death resulted from infection rather than the accidental injury.
In these situations, the insurer may argue that the infection constitutes sickness or disease and therefore falls outside the coverage provided by the AD&D policy.
Disputes Over the Chain of Events
The central question in many infection related AD&D cases is whether the accident set in motion the chain of events that ultimately caused the death.
Example:
The insured is injured in a fall and undergoes surgery to repair the injury. A postoperative infection develops and later becomes fatal.
The insurer may argue that the infection, not the accident, caused the death. Beneficiaries often argue that the infection would never have occurred without the accidental injury that required treatment.
Medical Records Often Become Critical Evidence
In these cases, the dispute usually centers on the medical evidence surrounding the accident and the infection.
Important records often include:
Emergency room and hospital records from the accident
Surgical records and treatment notes
Laboratory results and infection diagnoses
Autopsy findings and death certificate entries
Physician opinions regarding the cause of death
These records may help clarify whether the infection developed as a direct result of the accidental injury.
Death Certificates and Contributing Causes
Death certificates sometimes list several contributing causes of death. For example, a certificate might identify sepsis or infection as the immediate cause while also referencing the original injury.
Insurers may rely on the infection listed on the death certificate to argue that the policy requirements for accidental death were not met.
However, the full medical record may reveal that the infection was a complication directly tied to the original accident.
Surgical Complications After an Accident
Another common situation occurs when an infection develops following surgery performed to treat an accidental injury.
Example:
The insured is injured in a vehicle accident and undergoes surgery to repair internal injuries. A postoperative infection develops and later leads to death.
The insurer may claim the surgical complication represents a medical condition rather than an accidental injury.
These disputes often turn on whether the surgery and subsequent infection were part of the natural chain of events following the accident.
Legal Help With AD&D Claim Denials
AD&D claim denials involving infection after an accident often involve complex medical and legal issues. The dispute typically centers on whether the accident caused the chain of events that resulted in death.
The Lassen Law Firm focuses exclusively on life insurance and accidental death disputes nationwide. Attorney Christian Lassen has more than 25 years of experience representing beneficiaries in denied, delayed, and contested insurance claims.
If an accidental death claim was denied because the insurer argues an infection caused the death rather than the accident, legal review can help determine whether the denial can be challenged.