Published by The Pellegrin Firm August 23, 2019

Accidental Death & Dismemberment (AD&D) insurance is an important planning tool families use to protect against the consequences of the accidental death of a loved one. In addition, these policies often cover loss of a limb, hearing, or vision due to accident, losses which can seriously affect earning capacity. These policies can be sold by themselves or as a rider to a traditional life insurance policy. Some people buy individual policies, and some people have AD&D insurance through their employer, in which case any disputes will generally be governed by the Employee Retirement Income Security Act of 1974 (ERISA).

Insurance companies that write AD&D policies include Unum, Symetra, American Fidelity, The Hartford, Nationwide, AIG, Lincoln National, United of Omaha and many others.

Disputes over entitlement to benefits is not uncommon. These policies are long and complicated and have many exclusions. Insurance companies often refuse to pay out due to allegations that the loss was not due to an “accident” as defined by the insurance policy and/or the law. Also, policies often have exclusions for suicide, non-prescribed drug use, and murder. Determining whether exclusions apply is not as simple as it may seem. For instance, insurance companies have denied AD&D payouts in car accident cases based on the allegation that intoxication contributed to the accident or the driver caused the car to crash intentionally.

Insurance companies must follow strict procedural rules in investigations of claims and appeals of denials. Engaging an attorney early in the process of challenging a denial is essential. A beneficiary challenging a denial must gather as much information as possible and submit it to the insurance company during the internal insurance appeal process in order to use it in court later.

Just because an AD&D payout has been denied, that is no reason to give up. Most lawyers handle these cases on contingency, and there is little to lose by hiring a lawyer to challenge a denial.