Accidental death and dismemberment (AD&D) insurance provides protection if a policyholder dies or becomes disabled as the direct result of an accident. Purchasing AD&D insurance, whether as a stand-alone policy or as a rider on a life insurance policy, may give people a feeling of security that they or their loved ones will be taken care of financially if they suddenly die or sustain a debilitating injury. However, as AD&D policies have many exclusions, an unexpected tragedy is often followed by more unexpected news: that the claim is denied.
AD&D insurance policies are rife with exclusions
As an accident is commonly defined as an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury, policyholders usually expect they will be covered for any unexpected event resulting in their death or disability. But insurance companies painstakingly put in exclusions to limit their liability.
Common exclusions include death or disability that results from:
- medical or surgical treatment
- cardiovascular events
- declared or undeclared acts of war or terrorism
- Armed Forces service
- air travel,
or engagement in certain high-risk activities, including:
- sky diving
- scuba diving
- mountain climbing
- bungee jumping, and
- motor vehicle racing.
If someone dies or becomes dismembered as a result of committing or attempting to commit a felony, driving under the influence of alcohol or drugs, drug overdose or suicide, it is often not covered. Further, accidents that are directly or indirectly caused by sickness or mental incapacity may also result in a denial of covered benefits.
Given these limitations, many common causes of sudden death or disability, such as drunk driving or medical conditions that cause tripping and falling or poor driving, are typically not covered. Perhaps more troubling is that medical malpractice, which is defined as an accident in law, is often excluded as well.
The definition of dismemberment is also limited
Beyond the limits imposed by the aforementioned exclusions, insurance companies further narrow their liability by strictly defining “dismemberment” in terms of the loss of a limb or the use of a specific body part, such as the eyes or ears, or paralysis. Coverage may be further limited to dismemberment that renders policyholders unable to perform their occupation or activities of daily living.
Time constraints add further roadblocks
When someone dies suddenly, the existence of such a policy might not occur or be known to family members or beneficiaries. But unbeknownst to them, the clock is ticking: Notice of a claim must be filed within a set amount of time following the event. Further, insurance companies often have limits as to how much time can pass between the accident and the death or permanent injury.
What to expect when a claim is filed
When an AD&D claim is submitted, the insurance company will investigate how the individual died or suffered injury, which may include a review of medical records, both pre- and post-accident, and interviews with witnesses who saw the accident or who can provide information regarding the insured’s condition before or afterward. Given the wide range of policy conditions and exclusions discussed above, insurance companies have many ways to try to justify a denial of coverage.
Insurance companies stand ready to dispute any claim, so policyholders or beneficiaries should prepare, too, by gathering medical records, putting witnesses on notice and consulting a disability insurance attorney.
If your AD&D insurance claim is being challenged or has been denied, give us a call. We have the experience and tenacity to take on insurance companies who wrongfully challenge AD&D claims.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack