Accidental Death and Dismemberment Lawyer San Diego, CA

Accidental Death and Dismemberment

Explore Your Legal Options With Our Accidental Death and Dismemberment Attorney

Accidental death and dismemberment insurance policies provide financial security in the event of a loved one’s demise or accidental dismemberment. These policies also guarantee that the insured will receive a specific sum of money if he or she suffers a dismemberment or other serious injury. But claiming insurance isn’t an easy process and a San Diego dismemberment attorney is here to ensure you receive what you are entitled to. Unfortunately, insurance companies frequently deny claims for accidental death and dismemberment policies and breach their promise to provide you with the benefits you believed you had secured. To increase their bottom line, insurers have a financial incentive to collect premiums and pay out fewer benefits. This conflict of interest could lead them to improperly deny your accidental death and dismemberment insurance claim. Our accidental death and dismemberment lawyer in San Diego, CA at Benner Law Firm has years of experience fighting insurance companies and is prepared to represent you.

Why Do I Need an Accidental Death and Dismemberment Lawyer in California?

Cases involving the Employee Retirement Income Security Act (ERISA) are tricky and puzzling. The insurer has only the amount of the policy to lose. This is why many businesses take the risk and deny claims. Even if the beneficiary files an appeal, the case may be denied permanently because the vast majority of individuals lack the experienced counsel required to submit a successful appeal.  Many clients make the error of submitting appeals that provide scant justification for payment. After that, no additional evidence will be permitted, the claim file will be closed, and the case may be lost before a lawsuit is filed. Insurers also deny accidental death and dismemberment (AD&D) claims by attempting to apply accidental death policy exclusions.  We take a hands-on approach to every AD&D insurance claim we handle at Benner Law Firm. This implies that we:
  • Spend time with our clients, listening to their stories and responding to their inquiries
  • Examine insurance company files and policy documentation carefully
  • Examine the claims of our clients and identify evidence gaps
  • Gather crucial evidence, including medical records, police and coroner’s reports, and toxicology records
  • Consult physicians, accident reconstruction specialists, engineers, and other experts who can help clarify claim issues, particularly when the cause of death is contested or unclear.
  • File appeals on time with the insurance company and federal or state courts 
  • Discuss with the insurance provider.
  • Inform our clients of their extensive legal options and recommend pragmatic, cost-effective, and in their best interests strategies.
Our versed accidental death and dismemberment lawyer in San Diego, CA understands the distinctions and knows how to handle both types of cases. Call us for assistance if your AD&D claim has been delayed for more than 30 days. In addition to determining whether the insurance company is responsible for death benefits, our accidental death and dismemberment lawyer in San Diego, CA can also determine whether you have the right to file a wrongful death claim.

What is Accidental Death and Dismemberment Insurance?

Accidental death and dismemberment insurance policies, also known as AD&D policies, pay a lump sum to the named beneficiary in the event of the insured’s accidental death or amputation. Accidental death and dismemberment are also known as AD&D. You or a loved one may be covered by AD&D insurance through your employer or life insurance. Employers may offer policies that cover the employee’s dependents or may extend AD&D coverage only while the employee is on a business trip. Benefits covered by the AD&D policy include:
  • Loss of use
  • Bereavement counseling
  • Rehabilitation
  • Daycare
  • Legal and financial counsel for the surviving family
  • Permanent total disability
  • The cost of education for children
  • Counseling for surviving victims

What Constitutes an Accidental Death?

Accidental death occurs when a person dies due to any cause other than natural causes. For instance, if the insured passes away due to a car accident, homicide, or drowning, it is considered accidental death. If the insured died of cancer or a heart attack, this would be considered a natural cause of death. The death must occur within a specific timeframe, typically within 90 days of the accident.

What Constitutes Dismemberment?

Dismemberment is the loss of a limb (hand, leg, fingers, arm), paralysis, or a special sense (hearing, speech, vision). Numerous AD&D policies require the loss of two limbs or both eyesight. Some policies provide partial benefits for lesser losses, such as vision loss in one eye as opposed to both and amputation of one limb as opposed to two. Your policy may stipulate that if you lose one limb, you are eligible for 50% of your coverage amount. If your policy is not paying your dismemberment claim properly, you can contact our San Diego dismemberment attorney for assistance in filing a dismemberment lawsuit.

How to Qualify for Accidental Death and Dismemberment Benefits?

At its most fundamental level, AD&D insurance covers accidental deaths and dismemberments. Even though each insurer has its list of exceptions for what qualifies for death benefits under its guidelines, the following situations typically qualify for coverage: These situations are not guarantees of claim approval, and the insurance company will frequently consider the circumstances preceding the death.

What Are Accidental Death and Dismemberment Insurance Policy Exclusions?

Like other types of insurance policies, AD&D policies contain exclusions. There are strict exclusions because this policy only covers losses that the insured did not intend to occur or that result from natural causes. The exclusions found in most AD&D policies include:
  • Death resulting from the use of alcohol or nonprescription drugs
  • Death due to a mental disorder
  • Car races in which the insured was a driver or passenger
  • Sickness or disease
  • Piloting an aircraft or serving as a flight attendant
  • Suicide
  • Armed conflict-related fatalities

What is the “Sickness” Exclusion in AD&D Policies?

Sickness exclusion is one of the most common AD&D policy exclusions. This policy exclusion exempts the insurance company from paying for any death caused, contributed to, or resulting from a disease. It may be evident that the cause of death was an accident, but the insurance company may assert that an underlying illness contributed. If a person is hospitalized for disease and subsequently dies, the insurance company may be able to deny the claim that the death was accidental. When a person is involved in an accident and it is disputed whether a medical condition contributed to it, there is the most contention. For instance, illnesses with which people can live and function normally.  A “sickness” can be understood broadly or narrowly. A few instances in which an insurance company may attempt to deny a claim:
  • A person infected with COVID-19 dies in an accident unrelated to the coronavirus.
  • A person is taking prescription medication when they are killed by a car.
  • A fatal car accident occurs while a sick individual is en route to the emergency room.
  • An employee falls from a balcony while at work, and the insurance company determines that a history of epilepsy contributed to the accident.
  • A person who trips and falls while crossing the street is hospitalized for a broken hip and later dies of pneumonia after contracting the illness in the hospital.
  • An individual with a history of depression and mental illness dies in an accident that the insurance company believes may have been a suicide attempt.
  • A person was driving when they suffered a sudden aneurysm and then caused a fatal car accident.
  • A patient undergoing orthopedic surgery dies as a result of an anesthesiologist’s medical error.

How Can I Ensure That I Do Not Cause My Family Any Problems If They Need to Collect?

On the application, our accidental death and dismemberment lawyer in San Diego, CA advises those considering an AD&D policy, to be honest, and forthright. Although you may lie to obtain a lower premium, doing so could be detrimental to your family if the insurance company suspects you lied to obtain coverage. You can reduce the likelihood that your family’s AD&D life insurance claim will be questioned or denied by taking the following steps:
  • Be sincere in your application for ad&d life insurance
  • Spend considerable time answering the questionnaire
  • Request clarification if you do not understand a question or term
  • Review your application carefully

Why Do Life Insurance Companies Deny Accidental Death and Dismemberment Claims?

AD&D compensates victims for covered accidental death and dismemberment claims. Under the terms of the policy, not all deaths or dismemberments are covered. A life insurance company may have a legal justification for denying a claim for accidental death or dismemberment.  Some insurance companies, however, act in bad faith by denying valid life insurance claims. Among the reasons an insurer may give for denying an AD&D claim are the following:

Non-Accidental Death 

The cause of death was not an accident, such as a disease or a pre-existing medical condition. In some instances, it can be difficult to establish that a fatality was the direct result of an accident. The insurance company may argue that the accident was not the primary cause of death if the deceased had a preexisting condition or if other factors contributed to the death.

Intentional Deaths or Dismemberments 

The company may assert that the death or dismemberment was intentional. For example, the insured person committed suicide or was murdered by another individual. By arguing that the death was intentional, the insurance company shifts the burden of proving accidental death to the AD&D policy beneficiary.

Exclusions From Policy Coverage

There may be several exclusions in an AD&D policy. Exclusions are instances in which the insurance provider is not obligated to pay benefits, even if the insured has died or lost a limb. For instance, an AD&D policy may not cover fatalities caused by drunk or impaired driving, driving under the influence of alcohol, or using illegal drugs.

Medical Care or Medications Were the Cause of Death

If the individual received medical treatment following an accident, the company might assert that the treatment or lack thereof caused the individual’s death. When death does not occur immediately or within a short amount of time, the insurance company may argue that the death was not caused by accident but rather by other mitigating circumstances.

No Coverage

In some instances, the insurance company may assert that the AD&D policy has expired due to nonpayment of premiums. For employer-based policies, the employer may assert that the employee did not work long enough to be eligible for coverage.

Accusing the Insured

The insurer may blame the insured for the death or dismemberment. The company may deny the AD&D claim because the death or dismemberment was caused by the insured’s negligence or recklessness, thereby voiding the insurance coverage.

What Should I Do If the Life Insurance Company Denied My AD&D Claim?

Before filing an AD&D claim, carefully review your insurance policy. Note the coverage amounts, exclusions, deadlines for filing a claim, and any other pertinent information. Collect all accident-related documentation, such as medical records, witness statements, and accident reports. Keep copies of all accident- and claim-related documents. Follow the claim filing instructions carefully. Include the date, time, the individual’s name, and the specifics of each conversation with the insurance company in your notes. For an AD&D claim, records must be exhaustive. If the insurance company denies your claim, you typically have a very brief window of opportunity to appeal.  Numerous AD&D policies are governed by ERISA, a federal law. Regardless of the type of plan, ERISA gives the insurance company an unfair advantage and establishes specific rules and deadlines for filing an administrative appeal against a denial. These appeals are required before filing a lawsuit, and if you fail to submit all pertinent legal and factual support for your position, you will typically be precluded from introducing it at trial. AD&D appeals and litigation can be difficult. An individual may find it overwhelming, time-consuming, and expensive to fight a large insurance company. It may be beneficial and prudent to discuss your claim with our accidental death and dismemberment lawyer in San Diego, CA.

Call Our Law Firm Today Regarding Your AD&D Claims

Adding Accidental Death and Dismemberment (AD&D) benefits to a life insurance policy is a low-cost way to help ensure a family member’s financial stability during a time of great hardship. If your insurance company improperly denied the benefits to which you are entitled to your loved one’s accidental death or dismemberment life insurance claim, contact our San Diego dismemberment attorney who is experienced in handling such claims.  Benner Law Firm’s accidental death and dismemberment lawyer in San Diego, CA is eager to assist you in recovering the benefits to which you are entitled. Call us now for a free strategy session. We handle AD&D claims in the entirety of California, including San Diego.

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