If you are among the millions of Americans who pay accidental death and dismemberment (AD&D) insurance, you rightly anticipate that your policy will provide financial support when needed. Yet, the payout of such claims can be affected by various factors.
Typically, there are three reasons AD&D claims are denied:
- Intoxication: An individual was intoxicated at the time of their accident and is denied under the specific intoxication exclusion
- Dangerous Behavior/Activity: An individual does something so dangerous that their death is foreseeable, and thus not an accident
- Medical Causes: There is a debate as to what actually caused a death. For example, a person breaks their leg in a car accident, but medical negligence causes the actual death. An AD&D policy might not pay because it blames the medical cause, not the accident.
Insurers often utilize the intoxication exclusion clause within AD&D policies to avoid honoring claims suspected to involve alcohol consumption. If you or a loved one has faced denial of ERISA death and dismemberment benefits due to alleged alcohol use, seeking assistance from a seasoned insurance attorney could be pivotal in your pursuit of rightful compensation.
At Kantor & Kantor, we recognize the importance of compassionate and strategic legal representation in these trying times. Our attorneys specialize in navigating the intricacies of AD&D claims. We are steadfast in our commitment to advocating for our client’s rights and ensuring they receive the compensation they deserve. Contact us at 818-886-2525 for a free consultation.
We offer a free case evaluation to discuss how our attorneys can assist you. Contact us now at 818-886-2525 for a free consultation.
What Is Accidental Death and Dismemberment Insurance?
AD&D insurance, as the name implies, offers coverage in the event of death or dismemberment resulting from a qualifying accident. In the case of the insured’s demise due to a covered accident, the designated beneficiaries typically receive a lump-sum payment.
In the event of dismemberment resulting from a covered incident, most policies provide payouts ranging from 50% to 100%, depending on the type of injury and the extent of dismemberment. Dismemberment includes the loss of limbs, eyesight, speech, and hearing. If the loss involves one limb or one sense (eyesight, speech, or hearing), the policy usually pays out at a rate of 50%. However, the full benefit is generally paid if the loss extends to two limbs or more than one sense. Policies commonly offer payouts in cases of coma, partial or total paralysis, within the range of 25% to 50%.
What Is Covered by AD&D Insurance?
AD&D insurance provides coverage solely for injuries or death of the insured resulting from an accident. The death or injury must directly stem from the accident, and coverage does not extend to deaths caused by illnesses or natural causes.
Coverage typically includes injuries sustained at home or work and during travel. In cases where the insured’s death is a direct consequence of an accident while using public transportation, certain policies may payout at two or three times the coverage level.
For AD&D coverage to apply, death need not be instantaneous, but it must occur within a specified time following the accident, usually within a few months.
Some insurance providers offer optional AD&D coverage for spouses and children. Certain insurers also provide the option for an additional payout if the insured was wearing a seatbelt during a vehicle accident leading to death or dismemberment. Additional features such as financial advising, legal guidance, or counseling for surviving spouses can be included in some policies. Moreover, some policies offer optional hospital stay coverage following an accident.
Unraveling the Complexity in California Accidental Death and Dismemberment Lawsuits
Accidental Death and Dismemberment insurance provides crucial financial protection following unforeseen tragedies. However, navigating the nuances of AD&D claims can be challenging.
Accidents: Unforeseen and Unintentional
Accidents are characterized by their unforeseen and unintentional nature. They occur suddenly and unexpectedly, often resulting from circumstances beyond an individual’s control. Accidents can have devastating consequences for victims and their families. In AD&D claims, establishing that an incident qualifies as an accident is fundamental to pursuing compensation.
Intoxication: A Delicate Legal Terrain
Claims involving intoxication introduce a layer of complexity that requires careful navigation. When alcohol or drugs are involved, insurance providers may question the role of intoxication in contributing to the incident. Determining whether intoxication was a primary cause or merely a contributing factor requires thorough investigation and a deep understanding of legal precedents.
Proving Negligence vs. Unforeseeable Events
In cases of intoxication, insurers may argue that the individual’s impaired state was the primary cause of the incident, thereby absolving the insurer of liability. However, it is essential to differentiate between situations where negligence or reckless behavior led to the accident and those where the event was truly unforeseeable. Our legal team diligently examines the evidence to establish causation and liability, protecting our client’s rights.
What Is an Intoxication Exclusion?
An intoxication exclusion is a provision commonly found in insurance policies designed to limit or exclude coverage when injuries or damages result from the insured party being under the influence of alcohol, drugs, or other intoxicating substances. This exclusionary clause is particularly pertinent in various types of insurance, including auto, health, and life insurance.
Intoxication exclusions primarily aim to mitigate insurers’ risk and discourage reckless behavior. Insurance companies typically view intoxication as a contributing factor to accidents and believe that individuals who engage in such behavior should bear the responsibility for any resulting damages.
Intoxication exclusions can vary in scope and specificity depending on the type of insurance policy and the insurer. Some exclusions may explicitly state that coverage is void if the insured individual is intoxicated at the time of the incident, while others may provide more nuanced language regarding the influence of intoxication on the event.
Intoxication and AD&D Claims
Intoxication is often considered a contributing factor in accidents, raising questions about responsibility and liability. Insurance policies typically contain provisions addressing the exclusion or limitation of coverage when an accident involves alcohol or substance intoxication. When an individual’s intoxication contributes to an accident, insurers may use this as grounds to deny or limit benefits under an AD&D policy.
Not all cases involving intoxication are treated equally. California law acknowledges varying degrees of intoxication and considers factors such as the foreseeability of harm. While extreme intoxication may be more likely to result in a denial of benefits, our legal team understands the importance of examining the specific details of each case. We will work diligently to establish whether the intoxication was a primary cause of the accident or if other contributing factors were at play.
Intoxication Exclusion Laws
Insurance exclusion laws vary from state to state, with each jurisdiction adopting its own stance. While some states have no specific regulations, leaving the resolution of such matters to individual insurance companies, claimants, and the courts, others expressly prohibit the practice. Several states explicitly permit insurance companies, particularly those under ERISA, to employ exclusions, absolving them of responsibility for losses incurred when the insured is intoxicated or under the influence of non-prescription drugs.
ERISA insurance carriers are not obligated by law to cover losses resulting from the insured’s intoxication or non-prescription drug use. In cases where the insured’s intoxication is a factor, an insurance lawyer may assist claimants and their families in navigating the complexities of accessing California accidental death and dismemberment insurance claims benefits. Some claimants may not have consumed sufficient alcohol or substances to contribute to an accident, while others may find the interpretation of the insurance policy open to multiple perspectives. The ambiguity of insurance terms and the selective applicability of certain contract provisions to specific circumstances can further complicate matters.
Why Choose Kantor & Kantor?
At Kantor & Kantor, we recognize the profound impact that unexpected tragedies can have on individuals and families. Our firm is dedicated to providing compassionate and effective legal representation for clients navigating these complexities. Here are some compelling reasons to choose us:
1. Expertise in AD&D Claims
With decades of experience handling AD&D cases, we have established ourselves as a trusted authority in insurance law. Our attorneys understand the nuances surrounding AD&D claims, including the intricate distinctions between accidents and incidents involving intoxication.
2. Comprehensive Understanding of California Laws
We are based in California, and our legal team is well-versed in the state’s specific laws governing AD&D cases. We understand the nuances and intricacies of California’s legal framework, enabling us to provide you with tailored advice and representation that aligns with the unique aspects of your case.
3. Diligent Investigation and Case Preparation
In AD&D cases, the thoroughness of the investigation is crucial. Our team at Kantor & Kantor leaves no stone unturned in examining the details of your case. Whether it involves untangling the events leading to the incident or discerning the role of intoxication, we conduct a meticulous analysis to build a robust case on your behalf.
4. Skilled Negotiation and Litigation
Negotiating with insurance companies can be challenging. Our attorneys are skilled negotiators who advocate for your rights and ensure you receive fair compensation. If litigation becomes necessary, we are prepared to represent you with tenacity in the courtroom.
5. Proven Success in AD&D Cases
Our firm’s history is marked by successful resolutions in various AD&D cases. We have a reputation for securing favorable outcomes for our clients, demonstrating our commitment to achieving justice in even the most complex situations.
We are people helping people, and we believe in justice. Contact us today at 818-886-2525 for a free consultation.
How We Can Help
At Kantor & Kantor, our seasoned legal team focuses on AD&D cases, offering personalized and comprehensive support to our clients. Here is how we can assist you:
Full-scale Investigation
Our legal experts conduct a thorough and meticulous investigation into the circumstances surrounding the incident. By gathering evidence, consulting witnesses, and collaborating with experts in relevant fields, we ensure a comprehensive understanding of the events leading to the AD&D claim. This detailed approach helps strengthen your case, offering a solid foundation for negotiations or litigation.
Negotiation With Insurance Companies
Insurance companies may attempt to minimize payouts or deny claims altogether. Our seasoned negotiators are adept at dealing with insurance providers, advocating on your behalf to secure a fair and just settlement.
Trial Proficiency
In cases where negotiation falls short, our skilled litigators are prepared to take your case to court. With a successful track record in California courts and across the country, we stand ready to assert your rights and pursue the compensation you deserve.
Well-practiced Proactive Approach
Time is of the essence in AD&D claims. Our firm takes a proactive approach, swiftly gathering evidence, filing necessary paperwork, and initiating negotiations with insurance companies. By acting decisively, we strive to expedite the resolution of your claim while safeguarding your rights and interests.
Contact Our Insurance Attorneys Today
If you are dealing with an accidental death and dismemberment insurance claim in California, Kantor & Kantor is here to help. Our dedicated legal team is well-versed in the complexities of California law, including the nuanced distinctions between accidents and incidents involving intoxication.
Do not navigate these challenges alone – we are people helping people, and we can advocate for justice and fair compensation for you. Contact Kantor & Kantor at 818-886-2525 for a free consultation.
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]