Accidental Death Insurance Payouts: What to Do if Your AD&D Claim for Benefits Is Denied

Along with a life insurance plan, getting accidental death and dismemberment coverage is a good option to prepare yourself for unexpected incidents. Unfortunately, AD & D claims are usually declined by the insurance company due to various reasons. 

Maybe you are expecting a smooth process to claim your insurance, but after claiming you will get to know that the insurer is making the process complicated for you. It will also act unreasonably by delaying or even denying the insurance claim. Hence, AD and D insurance will be extraordinarily complex to navigate on your own. 

In this blog post, we will delve into reasons why AD and D insurance gets denied and what to do when your AD and D claims get denied. Let’s find out! 

Meaning: What is Accidental Death and Dismemberment Insurance? 

AD and D (Accidental Death and Dismemberment) insurance is an optional insurance plan that a person can buy to supplement his life insurance policy. However, some employers offer AD and D policies as a component of their employee benefits package. But AD and D can also be bought as a standalone plan and as a rider to the already existing life insurance plan. 

The policy offers security when the policyholder dies or is injured due to an accident. It only covers unexpected and unforeseen deaths and incidents regardless of the natural deaths even if they are sudden or from some illness. In addition, if accidental death insurance is offered by an employer, the plan is to be governed by ERISA. On the other hand, the claims will be controlled by state law. 

Accidental Death and Dismemberment differ from Life Insurance Plan 

AD and D policies when compared to life insurance policies, are different in coverage and benefits. Accidental death and dismemberment insurance will be paid only if the reason for the death is an accident like a car, truck, or any public transportation accident. Any death due to natural causes is not covered by this type of policy. However, it will pay the benefits in case of injuries that cause the injured person’s loss of limb, hearing, vision, or speech, or when injuries are proven, to be a result of an accident. 

A traditional life insurance policy will pay out the entire death benefit to the designated beneficiaries after the death of the policyholder regardless of the reasons for death. However, this policy will not cover any injuries or other losses due to accidents. 

What are the tactics insurance companies use to deny AD and D claims? 

Insurers can deny the claim by basing any allegation on weak or even non-existent evidence, or maybe by saying that the death was not accidental. The company can also refuse to pay the benefit amount if the death due to an accident that did not follow the accident instantly, takes weeks or months to take place. 

Another reason for denial is that the deceased acted negligently at the time of accidental death or maybe he had a stroke while driving and then died in a car accident. In that case, the insurance company will not pay the death benefit claiming that the stroke was the underlying cause of the death, not the accident. 

What are some common exclusions for accidental death and dismemberment insurance policies? 

Accidental death and dismemberment plans often have multiple exclusions. Some examples of exclusion include the death or death cause involved: 

  • Criminal activity
  • Suicide
  • Intoxication
  • Intake of illegal drugs 
  • Pregnancy or any other sickness at the time of the accident. 

What to do if your AD and D claim for a benefit is denied? 

For accidental death and dismemberment cases, the medical examiner carries out an autopsy if a sudden or unexpected death has occurred. It is necessary to get a copy of the autopsy report to support your AD and D claim. However, if the death cause is listed as natural on the death certificate, the insurer will deny the claim. But, commonly, a death certificate may have inaccurate information about the cause of the death. Another case would be that it does not fully consider whether the reasons for death were an accident or it was natural. 

In case your AD and D claim has been wrongfully denied, contacting a reputable and experienced attorney to deal with your case ASAP would be recommended. You have a very short time frame to appeal a denial and failure to this appeal timely will protect you from contesting the claim. A professional attorney understands how accidental death and dismemberment policy works. He also comes up with various strategies to support your claim. 

Does your claim fall under ERISA? 

It’s better to know whether your claim falls under ERISA. As mentioned earlier, many AD and D insurance plans are provided via employment. If the insurance is provided by your employer it will be governed by a super complex law known as the Employee Retirement Income Security Act (ERISA). If you lie under ERISA, once your claim is denied, you have strict timelines to make an administrative appeal of your claim denial. 

Additionally, the appeal procedure for this act is highly technical as you have to request the summary plan description and plan document. These records will give the appeal procedure for your claim along with details regarding accidental death and dismemberment coverage. Most importantly, you have to act fast if your AD and D claim has been denied as you may have as little as 60 days to appeal. 

Frequently Asked Questions (FAQs)

1- Does a regular life insurance plan cover accidental deaths? 

Yes, life insurance plans offer coverage for accidental deaths as well as deaths due to natural causes. No matter what is the reason for the death or whether the insured had AD and D insurance, life insurance covers the death. However, if the deceased had both a typical life insurance plan and AD and D and died accidentally, the beneficiaries will get both claims unless there is no exclusion applied. 

2- Does accidental life insurance cover natural deaths? 

No, unlike standard life insurance plans, this policy does not cover death by any natural cause or illness. Here are some questions most commonly asked about AD and D insurance claims and natural death causes: 

  • Is a heart attack considered accidental death? 
  • Is a stroke considered a natural death? 
  • Does the AD and D insurance plan cover cancer? 

All of the deaths mentioned above are deemed natural and are not according to the definition of an accident, the insurer will not pay the death benefit. 

3- Has COVID-19 been considered an accidental death? 

No, COVID-19-related deaths are considered due to natural causes not accidents. So, they are covered by general life insurance plans, but not by accidental death insurance plans. If the insured had both a life insurance plan with an accidental death rider and died due to COVID-19, the insurer will deny the accidental death rider amount and only pay the life insurance death benefit.