Category: AD&D
Accidental Death and Dismemberment lawyer

How Life Insurance Companies Classify Accidental Death

Find out how accidental death insurance works, what causes of death life insurance companies classify as accidental, and how to get the accidental death benefits paid in addition to the standard life insurance benefits from the nation’s top life insurance attorneys at Boonswang Law.

If you are a life insurance beneficiary and are having trouble getting your accidental death benefits paid, call us to discuss your case, free of charge. You can appeal the denial of your life insurance claim. We only take cases on a contingency, meaning, we do not get paid unless you do.

Accidental Death Insurance

Accidental death insurance, also called accidental death and dismemberment (AD&D) insurance, is usually an optional rider on a standard life insurance policy. An insured will pay extra for this coverage.

Types of Accidental Death Riders

Accidental death coverage may be offered by an employer to cover workplace accidents as a benefit, may be offered by an employer at the employee’s cost, may be an optional rider on an individual life insurance policy, and may be purchased for a limited period of time the insured is traveling.

What Accidental Death Policies Cover

An accidental death policy covers deaths caused by accidents, such as:

  • Vehicle crash
  • Drowning
  • Slips
  • Falls 
  • Burns
  • Choking
  • Machinery
  • Lightning strike
  • Heat stroke
  • Freezing to death
  • Homicide

Some policies also cover dismemberment, total or partial loss of hearing, vision, or speech, partial paralysis, and other permanent impairments caused by an accident. The life insurance company pays the insured benefits based on a schedule of what percentage of the accidental death benefit the insured’s injury is worth.

Determining Accidental Death Coverage

The amount of accidental death coverage someone needs depends on the nature of their profession, for example, if they work with or around hazardous substances or heavy machinery. People who travel regularly or even commute long distances might also consider purchasing accidental death coverage.

Common Exclusions in Accidental Death Policies

Hazardous activities or hobbies that the insured voluntarily engages in, such as extreme mountain climbing, bungee jumping, race car driving, or motocross will be excluded from coverage. 

Death due to acts of war or terrorism, illness, alcohol poisoning, drug overdose, or while performing an illegal act is also typically excluded. 

Do Normal Life Insurance Policies Cover Accidental Death?

Yes. Standard life insurance policies cover accidental death. An accidental rider to a life insurance policy increases the amount the beneficiary gets in death benefits if the insured’s death is accidental and not due to natural causes, illness, or any exclusion.

How a Life Insurance Company May Classify an Accidental Death

A life insurance company classifies a death as accidental when it is not caused by illness, natural causes, or any exclusion. Also, the death of the insured must occur within a period of time following the accident as set forth in the policy itself. 

Accidental death benefits typically expire when the insured reaches age 70, although this will be expressed in the policy. If it is and the insured dies of an accident after reaching age 70, the life insurance company will not pay the additional accidental death benefits unless these terms are amended.

Reasons a Life Insurance Company May Deny Accidental Death Claims

Like any other type of business, life insurance companies seek to make a profit. They only do so when they collect premiums and underpay or don’t pay beneficiaries’ claims. For this reason, a life insurance company will often balk at paying accidental death benefits, claiming that the death was not accidental. 

This problem often arises when an accident causes a “natural” cause of death. For example, when someone in a car accident is injured and also has a heart attack. Sometimes the death certificate lists the cause of death as the heart attack, when the heart attack would have not occurred but for the car accident.

Life insurance companies will also claim that the death was not caused by the accident, such as when the death occurs long after the accident, or that the time between the accident and the insured’s death exceeded the time limit set forth in the policy.

Talk with an Experienced Life Insurance Lawyer

We fight for the rights of beneficiaries to receive the accidental life insurance benefits they are due. Your loved one paid for this extra coverage – you deserve those benefits. Call or contact us to discuss your case. We will investigate and get you paid those accidental death benefits if at all possible.

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Is COVID-19 Covered By Your AD&D Policy? Maybe…

If you or someone close to you contracted the coronavirus, filed an AD&D claim, and the insurer denied your claim, call us. If there is a way to get your claim paid, we will find it.

If a loved one died of COVID-19 and your beneficiary claim for death benefits was denied, we can help you too.

Insurance companies routinely deny legitimate claims for life insurance benefits and AD&D benefits because those companies only make money when they don’t pay claims. If your claim has been denied, you should fight back with a team of experienced life insurance beneficiary attorneys at your side. 

Give us a call at 1-855-864-4335 to schedule your free, no-obligation consultation. We only get paid if we can get you paid!

Whole or Term Life Insurance Probably Covers Coronavirus

Life insurance companies classify certain causes of death as accidental. If the insured had an individual or group life insurance policy and died from COVID-19, beneficiaries’ claims should be paid. For policies written before the onset of the coronavirus pandemic, there is no pandemic exclusion, so COVID-19 deaths ought to be covered. Be aware that this may change for newly-written life insurance policies.

Three Reasons Why Your COVID-19 Life Insurance Claim May Be Denied

If you file a claim for life insurance benefits due to the coronavirus and your claim is denied, it may be due to one of the following three most common reasons.

Reason #1: Allegedly Inaccurate or Missing Information on the Insured’s Application or Medical Questionnaire

If the insured made a mistake or omitted information on his or her initial application for life insurance or medical questionnaire, the life insurance company will rescind the policy due to misrepresentation on the part of the insured and deny a claim for benefits.

We have helped many clients get the benefits they deserve when the insurance company alleges misrepresentation, but cannot prove that the insured acted with the intent to deceive. 

Many times the error or omission had nothing to do with the death or dismemberment of the insured, or it was the fault of the insurance agent who filled out those initial forms on behalf of the insured. Either way, we may be able to get that claim paid.

Reason #2: Lapse or Termination of Policy Due to Non-Payment of Premiums

This is common, but we have gotten claims paid when a group policy through the insured’s employer lapsed, but the insured was not given the required notices and life insurance conversion forms, and also when the insured died after a long illness having never received the required notices of termination. 

Call us and we will do the necessary research and find out if your claim should be paid despite a policy lapse or termination.

Reason #3: Death During the Two-Year Contestability Period

If the insured dies within two years of purchasing a life insurance policy, the insurance company has heightened powers to research the circumstances of the death, as well as the facts underlying the responses of the insured to the medical questionnaire and initial application. If any problem is found, even if unrelated to the death, the insurance company will attempt to use it to deny the claim.

This is no reason to give up. Our life insurance lawyers have gotten millions of dollars of these claims paid when they were unfairly denied during the contestability period.

A Stand-Alone AD&D Policy Might Not Cover Coronavirus

Most commonly, Accidental Death and Dismemberment (“AD&D”) coverage is added as a rider to an individual or group life insurance policy. In that case, the underlying policy itself would likely cover a COVID-19 death. The AD&D rider would probably not apply because the AD&D policy covers limited types of injuries or deaths from accidents, not from natural causes such as disease or illness caused by a virus.

For this reason, if an insured’s AD&D coverage is a stand-alone policy, it may not cover a COVID-19-related injury or death. However, if the insured caught the coronavirus but suffered an unrelated accident and was injured or died, the AD&D policy should cover the death. 

What about Accelerated Death Benefits (ADB)? If your claim for accelerated death benefits was denied, contact us for help.

Insurers Will Deny AD&D Claims Due to Coronavirus

Knowing insurance companies as we do, we suspect that they will deny AD&D claims when the insured had COVID-19, even if the injury or death was due to an accident and wholly unrelated to COVID-19. 

Don’t take no for an answer. Contact us and we can help you get your life insurance or AD&D claim paid.

Accidental Death and Dismemberment lawyer

Getting Accidental Death & Accidental Dismemberment Payouts

What is an AD&D policy?

Typically accidental death and dismemberment insurance (AD&D) is available as a rider to a life insurance policy or a health insurance policy. An AD&D rider covers the unintentional dismemberment or death of the owner of the policy. It is also referred to as a “double indemnity rider.”

Another type of rider you may be interested in is an accelerated death benefit rider, commonly called ADB, which pay out if the insured is diagnosed with a terminal illness.

These are the common types of AD&D policies:

  • Group Life Rider. Usually provided by an employer, and the AD&D benefit commonly equals the death benefit. Sometimes coverage for dependents is also offered.
  • Voluntary AD&D. Offered by an employer as an elective benefit for which employees pay extra.
  • Travel Accident AD&D. Employers provide a supplemental benefit that covers employees while traveling on a business trip.

Many AD&D policies only cover accidents that occur off the job, not on the job.

How does AD&D insurance work?

In the case of an accidental death, designated beneficiaries can receive both the benefit from the life insurance policy and the benefit from the AD&D rider. It is common for the AD&D benefit to equal the amount of death benefit provided in the life insurance policy, and beneficiaries can receive both – thus the “double” in “double indemnity rider.” If the insured died due to injuries sustained accidentally, the death must have occurred within a specific time period following the injury to be covered by the AD&D rider. This time will vary among policies and may be governed by state law.

In the case of accidental dismemberment of the insured, as defined in the rider itself, the insured will receive a total or partial payout. The percentage of total benefit payout for specific injuries will be set forth in a “schedule” listing various injuries, as part of the rider.

AD&D coverage commonly ends when the owner of the policy turns 70.

What qualifies for Accidental Death and Dismemberment?

What are examples of accidental death?

Life insurance companies classify certain types of death as accidental. Generally, AD&D riders cover death due to exceptional and unexpected circumstances such as:

  • car accidents;
  • drowning;
  • suffocating or choking to death;
  • freezing to death or heat stroke;
  • burns or fire;
  • homicide;
  • lightning strike;
  • death by heavy equipment;
  • falling.

What is the Number 1 cause of accidental death?

In 2018, the CDC reported that the number one cause of accidental death was poisoning, including drug overdose. The second and third leading accidental causes of death were auto accidents and falls.

Accidental Death and Dismemberment Exclusions

It is very important to note that exclusions exist in all Accidental Death and Dismemberment policies for which insurers will deny payment of benefits. Every policy will list exclusions from coverage, and they differ policy-to-policy.  Typically the list will include:

  • Death from natural causes (old age);
  • Death from illness or disease;
  • Suicide (within a certain time frame);
  • Alcohol or drug overdose (poisoning);
  • Death while under the influence of drugs or alcohol;
  • Injuries sustained in war, or death in war.

The policy will also set forth other circumstances, such as if the insured is injured or dies while committing a felony, or if the insured is a professional athlete who is injured or dies while playing his or her sport, or if the insured dies while engaging in a risky or hazardous hobby, such as sky diving or race car driving.

If you or someone you know is abusing alcohol or drugs call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-662-HELP (4357) for free and confidential help, 24 hours a day.

If you or someone you know is struggling with thoughts of suicide, call the National Suicide Prevention Hotline at 1-800-273-8255 to access their national network of local crisis centers that provide free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

My AD&D claim was denied due to an exclusion – what do I do?

If your claim is denied due to exclusion, let experienced AD&D attorneys help you get paid. In one recent case, for example, our lawyers were able to get the beneficiary paid when the insured fell down a flight of stairs at work and died in the hospital the next day of extensive internal bleeding. The insured also had cirrhosis of the liver. We successfully argued that the pre-existing condition had nothing to do with the death of the insured.

While we cannot guarantee the same result in other matters involving the same facts, we often do get these claims paid.

Is a heart attack considered an accidental death?

Not usually, since a heart attack is usually preceded by a period of illness such as coronary artery disease. The same commonly applies to death by cancer or stroke.

Does AD&D cover drug overdose?

It depends. Was the drug illegal or was it prescribed by a doctor or available over-the-counter? If the overdose was an accident and the insured was prescribed the drug(s), there is always an argument to be made that the beneficiaries should be paid.

If your claim was denied because the insured died from a drug overdose, contact an experienced AD&D attorney to discuss your case – you may yet get paid. In another recent case, we got a beneficiary paid when the insured died as a result of blunt force trauma sustained in a motorcycle accident which left him in the hospital for a month under a DNR order until he finally passed. Our client’s claim was initially denied due to the “acute amphetamine intoxication” of the insured when the accident occurred.

We successfully argued that while operating a motorcycle while intoxicated was negligence, it was still not foreseeable that a motorcycle accident would occur, therefore it was an accident and covered by the AD&D policy.  Our client was paid. Again, we cannot guarantee the same result in any other matter but our success rate is high.

Accidental death payouts and accidental dismemberment payouts

We can assist an insured in obtaining an AD&D payout if he or she is accidentally seriously injured or suffers dismemberment and no exclusion applies. If the insured dies accidentally or from injuries suffered accidentally, we can help the designated beneficiary obtain the payout if no exclusion applies.

The kind of injuries covered by AD&D includes the loss of use or total loss of a body part, such as a limb or an eye, or important bodily function, such as speech or hearing.

Every policy has different limitations, and the insured should always read the terms of the policy carefully. Examples of injuries that an AD&D policy typically covers include:

  • Loss or loss of use of a limb;
  • Partial or total paralysis;
  • Total or partial loss of sight;
  • Total of partial loss of hearing;
  • Total or partial loss of speech.

While every insurance company offers different coverage and limitations on an AD&D rider, it is unlikely that insurers will pay 100% of the benefit to the insured unless the injuries are extreme, such as if the insured loses a limb and a major bodily function like sight or hearing, or loses two limbs, or is totally paralyzed..

AD&D loss of one limb payouts

This is a frequent cause of litigation, as the insured will believe that the injury is more serious and the AD&D policy should pay a greater percentage of the benefit, and the insurer will argue that the injury is less serious and offers to pay less or even none of the benefit. An experienced life insurance attorney can help you get paid what you deserve in this situation.

What to Do If Your AD&D Claim is Denied

There are many common reasons life insurance claims are denied. These are the typical causes of AD&D claim denial:

  • The accident did not “directly cause” the death or dismemberment or because the death or death occurred too long after the accident;
  • The policy lapsed or was terminated due to unpaid premiums;
  • In the case of employer-provided AD&D coverage, the employee allegedly did not meet the requirements for coverage (e.g., not employed for long enough, not working enough hours, etc.).

If the insurer denies your claim due to policy lapse or termination, or because the employee did not meet the requirements for coverage, contact an experienced AD&D lawyer to help you find out if that is actually the case. Often, there are applicable grace periods or administrative errors that can account for the denial and we can get the denial overturned.

As for denial due to non-accidental death, usually the cause of death is set forth on the insured’s death certificate and the insurance company will make a decision whether to pay out based on that. But what if the information on the death certificate is not, on its face, the whole story?

In one case, we got our beneficiary client paid when the insured drowned, but the death certificate set forth that death “was due to natural causes, relating to an existing heart condition.” We successfully argued that whether an event is an accident depends upon whether it was naturally and probably expected, and the insured would have no reason to expect that he would drown. Again, while we have been successful in overturning many claim denials in cases such as this, we cannot guarantee the same or similar result in any other matter.

If your claim was denied but you believe you have a legitimate claim due to accidental death or dismemberment, try these steps to get paid:

  • Ask the insurer to launch an investigation into the death to determine whether it was accidental;
  • Contact an experienced AD&D attorney to advance your case, especially if the insurance company refuses to investigate.

We have been successful in getting thousands of beneficiaries paid over the years and we can likely help you.

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