Accidental Death Insurance Policy Disputes—What to Look For.

Accidental death insurance policies are designed to provide beneficiaries with a measure of financial security when a loved one dies unexpectedly due to an accident. These insurance policies seem straightforward, but they frequently become the center of disputes when insurance companies deny claims. Here are some of the common issues we see as attorneys when we are faced with such a dispute. 

Defining "Accidental Death" At the heart of many disputes is the definition of "accidental death" in the policy.  These policies cover deaths that result from accidents. However, the insurance companies often argue over what constitutes an accident. For instance, if the deceased had a medical condition that contributed to an injury causing death, the insurer may argue the death was not purely accidental.

Exclusions and Clauses Insurance policies come with exclusions, which are circumstances under which the policy does not pay out. Common exclusions include death due to intoxication, drug overdose, or committing a crime.

Proof and Documentation Beneficiaries must provide the insurance company with proof that the death meets the terms of the policy. Disputes can arise over whether the proof of accidental death is sufficient.  In situations where an autopsy is not performed or where the cause of death is not clear, insurers may deny the claim citing a lack of clear evidence.

Timeliness Policy terms usually specify a deadline for filing the claim. Failing to meet these deadlines can result in your case being denied.

Claims Investigation Insurance companies carry out investigations to verify claims, which can lead to disputes, especially if the investigation is lengthy. Beneficiaries may contest the findings of the insurance company's investigation, which may seem biased against paying out the claim.

Policyholder Misrepresentation If insurers believe the policyholder misrepresented their health or other risk factors at the time of application, they may deny a claim.

Suicide Clauses Most policies exclude suicide, but distinguishing between suicide and accidental death can be challenging. Issues like undiagnosed mental illness or ambiguous circumstances surrounding the death can add complexity to these determinations.

The Impact of State Laws Insurance is regulated at the state level, and variations in state laws can impact disputes. Beneficiaries may argue that certain state provisions mandate a claim's approval even when the insurer disagrees.

So how do you deal with these potential disputes? 

  • Read the Policy Carefully.
  • Gather Evidence: All relevant documents, including the death certificate, police reports, and medical records, should be collected. If you believe there is some question that your loved one died due to an accident, you may want to request that an autopsy be performed at the hospital. 
  • Meet Deadlines.
  • Seek Legal Advice: An attorney specializing in insurance law can offer guidance and, if necessary, litigation support.

While accidental death insurance is designed to provide peace of mind, the disputes that arise challenge this intent. Sometimes, life insurance policies carry an accidental death provision that can increase the value of the life insurance claim.  It is a very emotional time after a loved one dies in an accident, so it is easy to postpone dealing with the business of life and accidental death insurance after the death. 

If you unfortunately lost a loved one due to an accident, feel free to call us at 314-315-8111 for a free review of your life and/or accidental death policy to see if we can help. 

Jill S. Bollwerk
Helping St. Louis area residents with personal injury, workers' compensation & insurance appeals/disputes.
Comments are closed.