I get a lot of calls from people who have been denied an accidental death insurance claim. Accidental death insurance is life insurance with a lot of restrictions. The primary restriction of this life insurance is that the person must die from an accident. But what most people do not know is that there are many other restrictions within these policies. One of the standard restrictions is that there cannot be any other related factors that would cause the death. How this becomes so confusing is that many death certificates will list a primary cause of death as accidental. But it is the related factors that determine if a benefit will be paid.
If someone dies of a drug overdose, prescribed or not, the death certificate will often state the cause of death as accidental. The related factor is, of course, that the accident was due to a drug overdose. Drug overdose is rarely covered in an accidental death insurance policy. One woman called after her accidental death claim was denied and said her father died when he fell off of a fire escape. When the blood test results were reviewed it turned out her father had a blood alcohol level above the legal limit for his state. The insurance company denied the claim stating the accident wouldn’t have occurred if he hadn’t been drinking and they have a restriction against alcohol related injuries. Another man contacted us for help after his wife fell and hit her head and subsequently died. The death certificate stated a cause of death as accidental due to blunt head injury. The insurance company reviewed her medical records and found that she had common dizzy spells and they therefore did not owe the claim because she had a medical condition that caused her to fall. That case is still pending.
So when is an accident not an accident? The answer; when it is restricted by an accidental death insurance policy.
There have been many lawsuits where people have fought denied accidental death claims. In some cases the beneficiaries have won and some they have lost. If you have a claim that has been denied you should consult an expert for their advice. Insurance companies do not want to pay claims and they will often make you fight to get your claim paid so be prepared.
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