There may be no area of insurance law with more complications and twists and turns than Accidental Death & Disability Insurance. The policy beneficiary will often think, My loved one drowned, or died in a car crash, or had the misfortune to die from taking too much of a prescription medication. The beneficiary thinks, The death was clearly an accident, and I should be receiving the death benefit.
Unfortunately, the insurance company responsible for paying the claim may think otherwise. Even though the layperson believes the death resulted from a car accident, the insurance company may rely on complicated policy language to deny the claim.
- The drowning may have occurred because the insured had a medical seizure or a heart attack. But for the medical complication, the death might not have occurred. Alternatively, but for the fact that the medical situation arose in water, the medical issue would not have led to death.
- The car accident may have clearly been an accident from the perspective of the layperson, but was the driver under the influence of drugs or alcohol? The insurance company may try to rely upon a policy exclusion to deny coverage.
- The drug overdose, even though resulting from taking prescription medication, might be rejected as an accident by the insurance company based on an argument that the medication was not taken strictly as “prescribed.”
We have seen many situations like these where the insurance company views facts through its own lens in a fashion which gives it justification to deny the claim. However, that justification may not be supported by the facts and the law. Over the past 20 years, Kantor & Kantor has successfully litigated dozens and dozens of these cases and has a strong track record of convincing the insurance company, or convincing a court when the insurance company remains firm in its denial, that given the facts, the policy provisions, and the law, the claim is payable.
NEVER GIVE UP WITHOUT CONSULTING AN ATTORNEY WITH EXPERIENCE IN LITIGATING ACCIDENTAL DEATH CLAIMS. We might be able to help you, or we might have to explain that the claim is not payable under the terms of the policy. However, only a lawyer who understands the law and its application to accidental death claims will be able to provide you with the analysis you need to decide whether you have a fight you can win! Never accept the denial of an accidental death claim without first consulting a firm with the proper experience in these types of claim disputes. Kantor & Kantor.
Denied Claim for Accidental Death Benefits
Our Attorneys Zealously Fight for Our Clients
When an accident takes the life of your loved one, the shock can throw you off balance as you deal with the aftermath of your loss. Then, when your accidental death claim is denied, you are left worrying about your finances instead of having the security you thought your policy would provide. It may seem clear that your loved one’s death was an accident, so it can be a surprise when the insurance company bases its denial on the allegation that it was not an accident. Payout of an accidental death claim can be very costly, so insurance companies will use every tactic they can to deny payment of claims.
Schedule your free case evaluation with an Accidental Death and Dismemberment claims denial attorney now. Call our Kantor & Kantor team at 818-886-2525 for help today.
Understanding Accidental Death and Dismemberment Insurance
Knowing the Details Can Help You Fight a Claim Denial
Accidental Death and Dismemberment (AD&D) insurance is a vital safeguard designed to provide financial protection to individuals and their loved ones in the unfortunate event of a tragic accident. AD&D insurance covers deaths that occur under certain circumstances which are considered accidents, such as car crashes, natural disasters, homicides, drownings, or unfortunate mishaps involving heavy equipment. In such cases, the coverage provides much-needed financial support to the grieving family and dependents.
Some of our clients wonder what an Accidental Death and Dismemberment policy will or will not cover. Typically, an Accidental Death and Dismemberment policy stipulates that an accident must be the “sole” cause of the death, separate from all other causes. What does that mean? When a claim is made, it means whatever the insurance company says it means! However, that is not the end of the story. Insurance companies, by law, are to look for reasons to pay a claim, not merely for reasons to deny it. Unfortunately, that is not how insurance companies stay profitable. In reality, the goal of an insurance company considering AD&D claims is to find justification to deny the claim, SO IT KEEPS THE BENEFITS.
But the insurance company’s initial refusal to pay a claim is not the end of the story! It is worth noting that the precise definition of what constitutes an “accident” is often left open to interpretation within insurance policies. When it comes to deciphering the definitions of words used in a policy, having a skilled lawyer on your side is essential, because a claim denial may depend on such definitions.
Sometimes, your attorney may have to prove what “accident” means in a trial. An important case regarding this issue, and whether a death was “foreseeable,” was argued in 19631. Even the Court understood that a seemingly simple word may be subject to debate. As the Court’s decision noted, “Everyone knows what an accident is until the word comes up in court.”
AD&D Policy or AD&D Plan?
Do You Have an Accidental Death and Dismemberment Insurance “Policy” or an Employer-Sponsored “Plan”?
While we refer to the document that provides your insurance coverage as a “policy” because this is a term with which our clients are familiar, it is likely that you are part of a “plan” administered through your employer. How your AD&D claim denial case proceeds will be determined by whether or not your coverage is sponsored by your employer. Federal laws may apply, and they differ from state laws. In addition, the way in which a case is litigated varies when federal laws govern the AD&D claim denial. Our attorneys at Kantor & Kantor are based in California but handle cases nationwide and can fight on your behalf regardless of what state you live in.
Choose Kantor & Kantor to Fight for You
Put Our Experience and Record of Success on Your Side
You should expect full and timely payment of a valid claim. Anything less deserves legal representation from an attorney with exceptional expertise in cases involving Accidental Death and Dismemberment policies. Count on Kantor & Kantor to give you the best possible representation in negotiations and at trial. We’re located in California, but we serve clients throughout the country. Here are links to some of the Accidental Death cases we have won in court, resulting in our clients’ receiving the benefits to which they were entitled. (Include Links)
Extensive Experience Fighting Insurance Companies on Behalf of Thousands of Clients
Insurance companies use a wide range of tactics to deny or delay payment of AD&D claims. Our knowledge of those tactics means we will be prepared to challenge any unreasonable actions on the part of the insurer.
Unparalleled Record of Success with Complex Cases
Our team of attorneys at Kantor & Kantor has succeeded in dozens and dozens of cases involving accidental death claims initially denied by the insurance company. We are successful because we always have a detailed understanding of the laws governing what constitutes a payable claim based on the relevant case and statutory law. When you face a complicated legal battle, pick a law firm that knows how to fight and defeat insurance companies. Learn how we’ve helped past clients.
Skilled Attorneys in a Complex Area of Law
Our team of lawyers succeeds in battles with insurance companies in state and federal courts because we have extensive experience doing so – and we also keep abreast of changes in the law and of relevant court decisions that may impact how we argue on behalf of our clients.
We Treat Clients Like People, Not a File Number
You deserve compassion in a time like this. You have lost your loved one and suddenly the financial support you expected to receive is not there. Now you face the stress of worrying about bills while you are still grieving your loss.
Why Is an Accidental Death and Dismemberment Claim Denied?
Challenging the Company’s Reasons for Denying AD&D Claims
AD&D cases can be complex to battle during negotiations with insurance companies, and they’re even more difficult to litigate. Accidental Death and Dismemberment insurance policies are often long, complex, and full of exclusions. Knowing the reasons insurance companies rely upon to deny claims may help you understand how our attorneys will fight to get your claim paid.
What Are the Exclusions for Accidental Death and Dismemberment Claims?
- Policyholder recklessness caused the death. Perhaps your loved one enjoyed participating in a dangerous sport and died while doing so. That does not mean your AD&D claim should not be paid.
- Passage of time between the accident and death. Some policies limit the amount of time allowed between the accident and the subsequent death. Or a company may try to argue that medical issues that developed between the accident and your loved one’s passing caused their death, rather than the accident itself.
- Intoxication or Abuse of Drugs. Deaths that involve the use of alcohol or drugs, whether illegal or prescription, are particularly challenging to address in a legal claim. The fact that alcohol or drugs were in your loved one’s system at the time of their death does not necessarily mean the substance was the cause.
- Heart attack or stroke. Some people suffer from one of these terrible events while they are sitting at a desk at work, or while eating a meal at home, for example. But they can also happen while someone is on a ladder, in a car, or riding a bike. It is common for insurers to state that the mere occurrence of a stroke or heart attack means that the death was not accidental.
- Illness at the time of death. Other illnesses may be debilitating and exist at the time of death. Just as with a heart attack, that illness may cause significant issues, but being ill at the time of an accident may not preclude coverage of a policyholder’s death.
- Death was deliberate. Many policies exclude coverage if a death was ruled a suicide, and an insurance company may stretch to define a death as being self-inflicted.
- Flying by private aircraft. The circumstances of a crash or the wording of an exclusion can involve complexities that may make it possible to fight a denied AD&D claim.
Supporting Documentation to Fight an AD&D Claim Denial
It is difficult to take on an AD&D claim denial when you lack the knowledge of how to do so. That is why reliance on our experienced attorneys at Kantor & Kantor can bring you relief in this already difficult and emotional time. Our lawyers know what type of documentation you need to succeed in getting your Accidental Death and Dismemberment claim paid. We will examine the details of your loved one’s death and determine all the information that can help you win your case.
If your insurer claims that you provided insufficient evidence, you might be able to remedy the denied claim simply by providing additional evidence — police reports, medical reports, autopsy reports, or other related documentation. For example, an autopsy report that lists the manner of death as accidental, instead of natural, is an essential piece of evidence.
Is Your Accidental Death & Dismemberment Insurance Policy Provided by an Employer?
AD&D insurance is often provided through an employer. When that is the case, a particular federal law applies: the Employee Retirement Income Security Act (ERISA)2. One of the reasons Kantor & Kantor has such a strong record of success with AD&D cases is our significant and detailed knowledge of ERISA laws and cases. This is a highly complex area of law; if your attorney isn’t familiar with it, you may lose the benefits you should have received when your AD&D claim was unfairly denied.
The way in which an ERISA case proceeds is different than that of a privately purchased policy. When your loved one is insured through their employer, they are a member of a plan and claims are handled by an administrator. To fight a denied claim, you should be ready with all your documentation right from the start. When ERISA governs your case, you must go through the process of an administrative appeal of a denial before you can litigate.
Unique to an ERISA case, and highly important, is this limitation: Only the evidence you provide during your appeal will be considered when you go to trial. Thus, your attorney must prepare from the very start as if you are going to trial. There are other elements of an ERISA case that make it challenging to fight, which is why it’s essential to have an ERISA lawyer at Kantor & Kantor working on your AD&D claim denial case.
Don’t Give Up. Get Help.
Attorneys Skilled at Fighting Denial of Accidental Death Claims
When you are grieving the sudden loss of your loved one, it can consume your energy. On top of that heavy burden, if an insurance company denies your claim for Accidental Death and Dismemberment benefits, you may feel unable to muster the strength to fight for what you deserve. Kantor & Kantor will take up the battle on your behalf. Don’t take “no” as the final answer. Talk to our attorneys about your case and find out how we can help you fight an AD&D claim denial. Discuss your case with one of our lawyers today. Call us at 818-886-2525.
Sources
1 Brenneman v. St. Paul Fire and Marine Ins. Co., 411 Pa. 409, 192 A.2d 745, 747 (1963) https://law.justia.com/cases/pennsylvania/supreme-court/1963/411-pa-409-0.html
2 Employee Retirement Income Security Act of 1974 [Public Law 93-406] https://www.govinfo.gov/content/pkg/COMPS-896/pdf/COMPS-896.pdf
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
