AD&D vs. Standard Life Insurance 
When dealing with a life insurance claim after a winter accident, it’s crucial to understand the two main types of coverage that may be in place: Accidental Death & Dismemberment (AD&D) and standard life insurance. Both offer protection, but the terms of coverage can vary significantly, and these differences are important when a claim is disputed.
- Accidental Death & Dismemberment (AD&D): AD&D insurance specifically covers accidents that result in death or dismemberment, such as losing a limb or becoming permanently disabled due to an accident. However, the key term here is “accident,” and the policy generally only pays out in cases where death or injury is directly caused by an accident. For instance, if someone dies due to a car crash caused by winter road conditions, the AD&D policy would likely cover the claim, but only if the accident is deemed to meet the strict criteria outlined in the policy. AD&D policies tend to have a more limited scope of coverage. If the person involved in a winter accident was engaged in activities not covered by the policy, such as driving under the influence of alcohol or drugs, or engaging in reckless behavior, the insurer could use these as reasons to deny the claim.
- Standard Life Insurance: Unlike AD&D, standard life insurance policies are broader and cover death regardless of the cause. This means that if a person passes away from a natural cause, illness, or accident, the beneficiaries are typically entitled to receive the death benefit. However, this does not mean that these claims are immune to scrutiny. Insurance companies may still challenge claims, especially if there is ambiguity surrounding the cause of death. One of the most common reasons for a standard life insurance denial is the presence of an exclusion clause, where the policy specifies certain circumstances under which the insurer will not pay out. For example, a policy may exclude death resulting from certain risky activities, or it may contain provisions regarding pre-existing conditions.
Common Reasons for Denials of Winter Accident Claims
Winter accidents, particularly those involving icy roads or severe weather conditions, often lead to significant injuries or fatalities. However, insurers frequently deny claims based on technicalities or misinterpretation of policy terms. Understanding the common reasons for denial can help beneficiaries identify areas where they may be able to challenge the insurer’s decision.- Accident Exclusions: Many insurance policies, especially AD&D policies, include exclusions for certain types of accidents. For example, if the insured individual was involved in an accident while driving under the influence of alcohol or drugs, this could lead to a denial. Additionally, some policies exclude accidents that occur while engaging in certain high-risk activities, such as snowboarding or driving on dangerous roads during winter storms.
- Failure to Prove the Cause of Death: In some cases, the insurance company may refuse to pay out a claim if there is insufficient evidence linking the cause of death to the accident. For example, if a person dies in a car crash during a snowstorm, the insurer may argue that the cause of death was not due to the accident itself, but rather a pre-existing medical condition or another factor that contributed to the incident.
- Delayed Claim Filing: Insurers often have strict deadlines for filing claims. If you miss the deadline, your claim may be automatically denied, regardless of the circumstances. It’s essential to file your claim promptly after an accident to avoid unnecessary complications.
- Material Misrepresentation or Omissions: If the insurer believes that the policyholder withheld or misrepresented information when applying for the policy, the company may deny the claim. For example, if the policyholder failed to disclose certain health conditions or previous driving violations, the insurer might argue that the policy is void.
We contacted Trief, Olk & Dror to help us with a life insurance issue and Shelly Friedland was the attorney assigned to our case. Before Shelly took our case she explained to us that the likelihood of our success without going to court was possible but not likely. Unfortunately we did not get the outcome we had hoped for but it was our decision to not move forward and have our case litigated. Shelly is very knowledgeable and was very straight-forward in her assessment of our case as we moved forward. She was very patient and thorough in answering our questions. She always responded in a timely manner and listened to our concerns. We would certainly recommend Shelly and would use her firm again in the future.”
- John Ramig
If there is any possibility of winning your life insurance case – this is the place to do it for you. They are efficient, honest and will achieve the best possible outcome.
Shelly Friedland worked on my case where a life insurance policy had lapsed and was even a few days beyond the grace period. Farmers had rejected my claim twice and was unwilling to take a second look. Shelly was able to get them to pay the entire claim without going to court, and the full amount was deposited in my account within a couple months. Highest recommendation.”
- Kathleen Brown
Trief, Olk & Dror is a superior law firm. Their attorneys and other legal professionals have a brilliant understanding of the law and the litigation process. They diligently perform their work in an efficient, strategic and cost-effective manner to ensure the best possible outcomes for their clients.
- Christopher Hughes
What to Do When Your Claim is Denied
If your life insurance claim is denied following a winter accident, there are steps you can take to challenge the decision and increase your chances of receiving the benefits you’re entitled to. The process can be complex, but with the right approach, you may be able to overturn the insurer’s decision.- Review Your Policy: Carefully read through the terms and conditions of the policy to understand why your claim was denied. Pay close attention to exclusion clauses, deadlines, and any other details that could impact the outcome of your claim.
- Gather Supporting Evidence: One of the most important things you can do when fighting a denied claim is to gather evidence. This could include police reports, medical records, photographs of the accident scene, witness statements, and any other documentation that helps to prove your case. The more evidence you have, the stronger your position will be.
- Request a Written Explanation: If you haven’t already received a detailed written explanation from the insurer, request one. The insurer is required to provide an explanation of why your claim was denied. This information can help you understand the reasoning behind the decision and identify any areas where the insurer may have made an error.
- File an Appeal: If you believe the denial was wrongful, you have the right to file an appeal. Most insurance companies have a formal appeals process that allows you to submit additional evidence or provide clarifications regarding the claim. Be sure to follow the proper procedures and timelines to ensure that your appeal is heard.
- Consult with an Attorney: If your claim has been denied, especially after a winter accident, it may be time to consult with an attorney who specializes in insurance disputes. At Trief, Olk & Dror, we have extensive experience helping individuals fight back against denied life insurance claims. Our team can help you navigate the complex claims process and provide you with the legal support you need to secure the benefits you deserve.