Accidental Death Insurance Claims
It’s a well known industry truth that most accidental death insurance claims will be rejected. Even when a death certificates states the manner of death as Accident, most accidental death insurance claims will be refused by the insurer.
Time and time again we have conducted in-depth claim investigations on accidental death claims and been able to successfully reverse the insurer’s denial. Insurers never do the detailed fact finding that we do. This makes the difference. Insurers will deny accidental death insurance claims based on limited facts and information. They just look closely enough to find a reason to deny, then they force the beneficiary to fight them.
We do the fighting, and win. We’ve prevailed even with some of the most challenging accidental claims like drug overdose, driving while intoxicated, medical malpractice and alleged suicide.
If you need help with an accidental death insurance claim call us now.
888-428-4868
Does this describe you:
Your accidental death claim was denied. You disagree with the denial. You want to appeal the claim denial. Now what?
Accidental death claims are very difficult to get paid because the policies have many exclusions. You have to understand both the policy and the process for proving a death was an accident that should be covered by the policy.
Accidental Death Insurance & Exclusions
Every Accidental Death policy has a section that lists the Exclusions. These are all the reasons an insurer doesn’t have to pay a claim even if the death was ruled to be an accident on the death certificate. The exclusion commonly include things like Intoxication, Committing a Crime, and Suicide.
The most challenging of reasons is an exclusion that says if there is any contributing medical condition the insurer doesn’t have to pay. Most people have some sort of medical condition, so this opens the door for insurers to get out of paying claims. But the most important factor is if there is a clear direct line between the person’s death and their medical history.
One example is when a person is in a hospital for a heart condition. They get up in the night to use the bathroom, fall and hit their head and die. The insurer will argue they wouldn’t been in the hospital if they didn’t have a heart condition and therefore they wouldn’t have died. This may seem absurd but we’ve seen it many times.
We fight these types of actions by insurers. When they “interpret” a policy in their favor we step in and apply facts and science to get accidental death claims paid.
What Laws Apply to Accidental Death Claims?
First, you need to understand some very important rules of appealing an accidental death insurance claim. Accidental death insurance can be offered through an employee benefit plan or it can be purchased directly from an insurer. If a policy is offered as part of an employee benefit plan, Federal laws will apply to any appeal. If a policy is purchased directly from an insurer, then the insured’s State laws will apply. There are some important differences between Federal law and State law when it comes to appealing an accidental death claim.
Under Federal law you are only allowed one (1) appeal of the claim denial. After you use your one appeal, and the decision is not reversed, you will have to pursue the claim in Federal court. An appeal can be anything in writing asking the insurer to reconsider. Even something as simple as a letter from the beneficiary, stating that they disagree with the denial, will be considered an appeal. So a word of caution, do not waste your appeal by writing a letter of complaint. An appeal of a denied accidental death claim should include new evidence that has not been considered, relevant case law and documented facts.
Another important rule under Federal law is that you only have 60 days to file an appeal to the denied death claim. If you do not contact the insurer within 60 days of the accidental death claim denial, you are essentially giving-up your opportunity to appeal. In most instances you can ask the insurer for more time and they will grant the request.
Should You Cash the Premium Refund Check?
And finally, it is important to know that if the insurer denies the accidental death claim and includes a premium refund check with the denial letter, you waive your right to appeal the claim denial if you cash the check. This check is known as an excess premium refund. If you intend to appeal the claim denial, just hold the check.
By contrast to these important Federal rules for accidental death claim denials, those policies that are governed by State laws have some differences. State law does not have a provision for only one appeal letter. State law does, however, waive appeal rights if you cash the excess premium refund check. It’s always best to hold a premium refund check until you have spoken with a professional about your options.
Why Do You Need a Professional to Get Your Accidental Death Claim Paid?
Much has been written in the media regarding the difficulty of collecting benefits from an accidental death insurance policy. Its critical you understand your options and rights for appealing a denied claim (See the United States Department of Labor). Even if you have a valid argument against the denial, not knowing the rules could keep you from collecting your claim.
For professional help and representation in appealing accidental death insurance claims contact The Center for Life Insurance Disputes.
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