What Is Accidental Death and Dismemberment Insurance?
Accidental death and dismemberment insurance (AD&D) is most often made available as a rider to another insurance policy, either life or health insurance. Also called a double indemnity rider, it pays upon the unintentional death or dismemberment of the insured. Many AD&D policies only pay out when the accident occurs off the job, not on the job.
The three most common AD&D policies are employer-provided: Travel Accident AD&D, Voluntary AD&D, and Group Life Rider.
When Does AD&D Insurance Pay Out?
Accidental Dismemberment of the Insured
If the insured is accidentally injured he or she will receive a payout in proportion to their injury. A schedule of injuries and a percentage of the benefit paid for each is attached to the rider. Injuries typically covered by AD&D insurance include:
Total or partial loss of sight;
Total of partial loss of hearing;
Total or partial loss of speech;
Loss of use, of loss of a limb;
Paralysis (partial or total).
100% payout is usually not available except for extreme cases, such as total paralysis, or loss of a limb and sight, or loss of two limbs.
Accidental Death of the Insured
If the insured dies accidentally, the beneficiaries receive the benefit from the AD&D rider as well as from the underlying life insurance policy. Examples of accidental death covered by AD&D riders include death by:
The CDC reported that the number one cause of accidental death in 2018 was poisoning, which includes death by drug overdose. The second and third leading causes of accidental death were auto accidents and falls.
When an insured dies from being accidentally injured, typically the death must occur within a certain time period following the injury itself to be covered under AD&D.
All AD&D policies will list types of death that are excluded from coverage. Commonly, these exclusions will include death by:
natural causes, or old age;
illness or disease such as cancer or stroke;
heart attack, if preceded by illness;
poisoning, which includes alcohol and drug overdose;
while under the influence of drugs or alcohol;
injuries sustained in war;
Injuries sustained while committing a felony.
What You Can Do If Your AD&D Claim is Denied
Insurance companies only get make money when they DON’T pay out, so it should come as no surprise that AD&D claims are frequently denied or not paid fully according to the severity of the injury.
Insurers will commonly deny claims if they can argue that the accidental injury was not the cause of death of the insured because the death occurred too long after the injury was sustained. Insurers will also claim there are problems with the AD&D policy itself, such as the policy lapsed or terminated, or in the case of AD&D coverage provided through an employer, the employee did not satisfy the requirements for coverage. If the death certificate is inaccurate or does not tell the whole story of how the death was due to an accident, the insurer can deny claims on that basis. And when the insured is accidentally injured, the insurance company will commonly try to underpay, reasoning that the injury is less severe than it actually is.
Beneficiaries should not take no for an answer. First, contact the insurance company and ask for an investigation. Frequently there is an applicable grace period that would have extended coverage, or the employer should have continued making premium payments but did not, or the servicer of the policy made an administrative mistake. And as far as the death certificate goes, there are always arguments to be made that the death was unanticipated, especially if the insured died from an illness or disease that he or she was unaware of.
Regarding the severity of the injury, the insured should be sure to provide the insurance company with documented evidence from medical professionals in arguing that a larger payout is warranted.
About the Author
Chad G. Boonswang, Esq. is a life insurance beneficiary lawyer based in Philadelphia, PA who graduated from the University of Pennsylvania and Villanova University Charles Widger School of Law. Mr. Boonswang founded his practice in 2002 and has recovered tens of millions of dollars on behalf of his clients from life insurance claims and catastrophic injury cases.
Mr. Boonswang has been selected as an ASLA 2014, 2015, 2016, 2017, and 2018 Top 10 Litigation Lawyer and year after year has earned a 10.00 “Superb” rating on Avvo. He also maintains an active blog on current events and issues in life insurance law and policy.
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