The beneficiary of an Accidental Death claim came to us after her claim was denied by the insurer. The cause of death was related to drugs, but also, arguably, an accident. What does that mean? It means that the death certificate, autopsy results and policy stipulations all must be considered together. In such instances the exact wording of the policy coverage and exclusions, the autopsy results, and the death certificate, together, must determine whether a benefit is owed. Frankly, this was not the thinking of the insurer.
Our client’s accidental death claim was denied. We appealed. The insurer, as is custom and practice, sent a letter of denial. We reviewed the letter, which quoted sections of the policy – both coverage and exclusions – in its explanation for the denial. We also reviewed the entire policy and the autopsy report.
After investigating the documents and the facts, we concluded the insurer had misinterpreted the exclusions of its policy. This isn’t uncommon. Consider how policies may be decades old, but the claims examiner may be new to the company. Or even, that the examiner is not trained in contract language and state insurance regulations. Many possibilities for wrongly denying a claim exist.
We documented all of the evidence of the claim. We presented exact policy language. We referenced the important documents. We argued against each item quoted in the denial letter. Respectfully, we demanded the claim be paid.
The claim was quickly reconsidered and paid. No lawyers. No legal fees. Start to finish in six weeks.
Accidental Death Claim
