Many people – especially breadwinners – purchase multiple types of insurance to protect their loved ones in the event they are killed or incapacitated and unable to work and provide financially. Our Houston Accidental Death and Dismemberment Insurance Attorneys have decades of experience representing clients with AD&D riders or separate AD&D insurance policies where the insurer is refusing to pay out after an accident.
AD&D Coverage Disputes
AD&D insurance policies only cover accidents. Death or injuries caused by illnesses (and various other non-accidental causes) are not eligible for benefits. This fundamental distinction forms the core of many coverage disputes between policyholders, beneficiaries, and AD&D insurance companies. Why?
Often, the circumstances surrounding a severe accident are unclear. The policyholder may have suffered from a variety of pre-existing conditions. In the AD&D insurance context, insurers routinely base their denials on this lack of clarity with regard to the cause of the injuries or death at issue.
For example, if you are involved in a motor vehicle accident where you suffer severe injuries to your back, neck, and spine and your injuries lead to paralysis in your lower limbs, your claim for benefits may seem perfectly legitimate. But insurers will latch onto any confusing factors that could be used to justify a claim denial.
The insurer will conduct a thorough investigation of the facts, which will likely include your medical history. Now, if the insurer discovers you were suffering from a degenerative spinal issue at the time of the accident, this may lead the insurer to argue that the paralysis of your limbs was caused by the natural progression of your degenerative illness and not by the motor vehicle accident.
Challenging an Accidental Death and Dismemberment Insurance Claim Denial
The particular procedures required to challenge a claim denial vary depending on the type of AD&D insurance policy that you have. If your AD&D insurance is funded by your employer, you may have to adhere to the complicated administrative appeal procedures mandated by the federal Employee Retirement Insurance Security Act (ERISA).
If you have an individual policy or a policy that is exempt from ERISA, then Texas state law will apply. This demands an entirely different set of procedures. Our insurance dispute attorneys have experience successfully resolving Accidental Death and Dismemberment insurance claims in accordance with both Texas state law and federal ERISA regulations.
Contact The Experienced Accidental Death and Dismemberment Insurance Claims Lawyers at Berg Plummer Johnson & Raval, LLP
Our Houston Accidental Death and Dismemberment Insurance Attorneys have decades of experience representing clients in a range of insurance disputes, including those that involve AD&D riders or separate AD&D insurance policies where the insurer is refusing to pay out after an accident. Call (713) 526-0200 or fill out the online form to find out your options.