Accidental Death and Dismemberment (AD&D) insurance coverage can be purchased as a stand-alone insurance policy, or it can be added as a rider to an existing life insurance policy. AD&D policies are often offered or sponsored by employers or private professional or fraternal organizations as a membership benefit. Unfortunately, they are a form of life insurance coverage controlled by insurance companies, and as such, they frequently fall prey to the many delay tactics and devices used by insurance companies to deny coverage.
The Law Offices of Mark S. Guralnick stands ready, willing and able to assist policyholders and their families to recover the AD&D coverage to which they are entitled.
What’s an “Accident?”
AD&D insurance benefits are paid only if death was the result of an accident. Defining an “accident,” however, is not as easy as one might think. A motor vehicle accident (car, truck) would seem to qualify under this definition, but if the victim was driving alone at the time of his death, the insurance company might insist that the accident was a suicide-by-vehicle and therefore excluded by the policy’s definition of “accident.” Any evidence that the driver was intoxicated while driving would also disqualify him from coverage under an AD&D policy,
AD&D policies provide benefits not only for the death of the policyholder, but for his or her dismemberment (loss of limb), and for his loss of hearing, vision and speech. In a typical policy, a policyholder is entitled to 50% of the full benefit if he loses a single limb, a hand, foot, sight in one eye, speech or hearing. If the policyholder loses two of any of such “members,” he would be entitled to the full benefit. In the event of the policyholder’s death, his beneficiary can collect benefits only if the beneficiary can provide that the death or injuries producing the death were the results of an accident.
Insurance Company Tactics
Insurance companies begin trying to avoid paying your claim even before you have made the claim. In the AD&D contract that you have signed, the insurance company has likely included multiple exclusions that allow them to deny your claim for AD&D benefits. Thus, when a loved has died as a result of an accident, the insurance company can deny the claim for a number of “exclusions” that appear in their contract with you. These exclusions generally indicate that the insurance company will not pay the claim under any of the following circumstances:
- Suicide or self-inflicted injury caused of the accident;
- Intoxication by alcohol or drug use caused the accident;
- Criminal activity was in the process of being perpetrated;
- The victim was suffering from a disease or a medical episode (such as a stroke or heart attack) that caused the accident;
- The victim was engaged in auto-erotic asphyxiation or autoerotism at the time;
- The victim was pregnant and/or was experiencing sickness at the time of the accident;
- The victim made a misrepresentation on the insurance application;
- The victim was actually suffering from a prior war injury, a prior work injury, or a prior athletic injury;
- The “accident” occurred during wartime, regardless of whether a “war” was declared or official or otherwise;
- The “accident” occurred at any point while the victim was in the military service of the United States or its allies, or any other foreign service;
- The injury occurred while on any aircraft as a pilot, crew member or student pilot, flight instructor or examiner;
- The claimant is not the designated beneficiary of the policy.
In addition to the exclusions that appear in the original insurance contract, the insurance company will examine the death certificate, police report and any investigative reports that are available to determine if the death has been classified as an “accidental death.” If an autopsy has been performed, the company will study the medical examiner’s report and any toxicology reports that were ordered as part of the investigation.
What We Do to Fight Back!
The Law Offices of Mark S. Guralnick does not sit idle while the life insurance company conducts its investigation. We conduct our own investigation. Unlike most life insurance lawyers, Mark S. Guralnick has more than 30 years’ experience practicing law AND he is a licensed private investigator with extensive field training. In addition. Mark S. Guralnick holds eight college degrees including a Ph.D. and five master’s degrees.
We don’t accept evasive statements and avoidance tactics by insurance companies. We immediately gather the evidence, present it to them, and challenge their assumptions. If the insurance company is not prepared to pay an appropriate claim, then we will file suit to recover the money that our clients are entitled to recover under the insurance policy.
The Law Offices of Mark S. Guralnick has the experience, the credentials and the resources to assist you. Contact us now at 1-866-337-2900 for a private, free legal case evaluation.