An accidental death policy offers protection when the insured dies as a result of an accident. Accidental death benefits may be found as part of a regular life insurance policy or as a separate contract.
Death certificate also records the date and time of death, which can be a crucial information for things like life insurance claim. Anyways, as per Registration of Births & Deaths Act, 1969, its mandatory to register death within 21 days of its occurrence and if you are late, then again you will have to do more paperwork and pay some charges. The first step to filing a death claim for life insurance is informing the life insurance company of the death and obtaining the proper forms from them to file the claim. You should try to get in touch with the agent the deceased worked with or any agent who works for the company directly. We understand the passing of a loved one is a very difficult time for those left behind. We have made the claim procedures for the death benefit as simple as possible, so you can focus on the things that most require your attention.
What Does Accidental Death And Dismemberment Insurance Cover?
Accidental death and dismemberment coverage provides protection if the insured dies in an accident or suffers a loss of limb/vision/hearing as a result of an accident.
Does Life Insurance Cover Accidental Death?
Life insurance policies cover accidental death as well as death to natural causes.
Accidental death policies usually offer extra benefits when the insured dies in an accident. If the insured had both a regular life insurance policy and an accidental death and dismemberment policy and died in an accident, the insurance company is obligated to pay both claims as long as none of the exclusions apply.
When Does Accidental Death And Dismemberment Coverage Pay?
The insurance company must pay your accidental death and dismemberment claim when it has all the records necessary to prove that the death was an accident. The insurance company needs to conduct an investigation. Since ADD policies pay only for accidental death, the insurance company will require all documents or records surrounding the death. Usually, they are police reports, medical examiner reports, toxicology report, etc. Once the documents are submitted and liability becomes clear, the insurance company must pay the claim promptly.
However, many accidental death claims are delayed for months and even years. The reason for the delay is usually an ongoing investigation. Even though most insurance companies need to pay claims within 30-60 days from the date of death, many insurers delay payment on the ground that they do not have sufficient evidence proving that the death was due to an accident.
How Does Accidental Death Insurance Work?
If the insured died in an accident, the beneficiary of an accidental death policy will file a claim with the insurance company. The insurance company will assign a claims examiner who will contact the beneficiary requesting documents proving that the death was accidental and not due to natural causes. A death certificate will generally classify the death as natural or accidental. However, insurance companies rarely rely on this classification alone. They will usually conduct an independent investigation into the cause of the death. Such records as toxicology reports and coroner’s reports are examined and become part of the record.
Proving that the death was accidental is not the only hurdle. Another common reason for ADD claim denial is the application of various ADD exclusions. An exclusion is a provision in a contract describing a situation when ADD benefits will not be payable. Almost all ADD policies have such exclusions. Many ADD policies will not pay ADD benefits if the death resulted from:
- intentionally self-inflicted Injury, suicide or attempted suicide, whether sane or insane;
- sickness or mental infirmity;
- war or act of war, whether declared or undeclared;
- Injury sustained while full-time in the armed forces of any country or international authority.
- Injury sustained while riding on any aircraft: a) as a pilot, crew member or student pilot; b) as a flight instructor or examiner;
- Injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed physician;
- Injury sustained while committing or attempting to commit a felony;
- Injury sustained as a result of being legally intoxicated from the use of alcohol.
- Injury sustained while operating a motor vehicle while legally intoxicated from the use of alcohol. )
Thus, even if the insured died in an accident, your ADD claim may be denied if the insurance company claims that the death is excluded from coverage for any of the reasons.
To avoid a claim delay and a potential denial of your ADD benefits, work with an experienced life insurance attorney. Our life insurance lawyers will work relentlessly on protecting your rights to the benefits you deserve.
How to Appeal a Denied Accidental Death Claim
We are here to provide assistance in handling denied accidental death claims. At our law firm, our accidental death claim attorneys have handled ADD claims denied because:
- The insured’s death was not accidental;
- A policy exclusion applied and cancelled coverage;
- The insured was intoxicated at the time of death;
- The insured took prescription medications that were not prescribed by a doctor;
- The insured died during a medical procedure, a surgery or post-surgical recovery;
- The insured was violating a law/participating in a felony/misdemeanor at the time of his/her death;
- The insured died due to a prescription medication overdose;
- The insured died of a sickness;
- The insured died in an accident, but his/her death was contributed to by a sickness;
- The insured died as a result of medical malpractice;
- The cause of death is unknown;
- The insured disappeared and was announced dead by disappearance;
- The insured died due to autoerotic asphyxiation;
- The insured was poisoned;
- The insured was murdered;
- The insured involuntarily ingested illicit drugs.
All of these reasons for denial are very common. It is true that every Accidental Death and Dismemberment Policy has several exclusions in it. A problem arises, however, when such exclusions get misinterpreted by the insurance company and based on them, your claim gets denied.
Insurance companies draft their policies using complex language that can sometimes be ambiguous and may have two or even more possible meanings. You may read it to mean that the coverage should exist while the insurance company claims that the same language denies coverage. If that happens, you need an experienced ADD attorney to review your case.
For example, if a drug exclusion or a sickness exclusion applies, you need a life insurance attorney who also understands the medical aspect of the claim.
Our ADD attorneys work with medical experts who review a toxicology report, a coroner’s report, a medical examiner’s report and a police report to determine whether the insurance company’s denial can be disputed. In many cases, medical experts’ opinions differ and the denial of benefits will be reviewed in court.
Under the law, courts look at the plain and ordinary language of the policy and use ambiguous language against the drafter of the documents – the insurance company. Our life insurance attorneys are skilled at reading insurance contracts.
We also have the experience needed to litigate ADD claim denials in state and federal courts. If your ADD claim has been denied for any reason, we are here to help. We will work with you through this difficult process so you do not have to face insurance companies alone.
Our life insurance law firm offers free consultations. We may ask you to provide us with copies of the documents that will help us evaluate your case. We work on a contingent fee basis and will zealously fight for your recovery.
Call us now at (888) 510-2212. Competitive contingent fees.
Policy Highlights
LIC Claim Procedure
Claim Settlement procedures for LIC policies.
LIC claim procedure is based on maturity and death aspects. Maturity claim procedure and Death claim procedure are explained below:
Procedure in case of Maturity Claims:
1) In case of Endowment type of Policies, the amount will be paid at the end of the policy period. A letter will be sent by the LIC branch offices which hold the policy stating the amount and date at which the amount is to be paid to the policyholder. All this process is being done at least two months before of date of payment. The policyholder is requested to return the Discharge Form duly completed along with the Policy Document. On receipt of these two documents, a post dated cheque is sent by post so as to reach the policyholder before the due date.
2) Some of the Plans have periodic payments such as Money Back Policies. These money back policies give periodic payments to policy holder as Survival Benefit. In some cases where amount payable is less than or up to Rs.60,000/-, cheques are released without calling for the Discharge form or Policy Document. However, in case of higher amounts that is more than 60,000/- both Discharge form and Policy Document are required.
Procedure in case of Death Claims:
Pli Death Claim Procedures
Death Claims:
The death claim amount is payable in case of policies where premiums are paid up-to-date or where the death occurs within the days of grace. On receipt of intimation of death of the Life Assured the Branch Office calls for the following requirements:
a) Claim form A – Claimant’s Statement giving details of the deceased and the claimant(Applicant).
b) Death Certificate.
c) Age proof, if age is not admitted
d) Evidence of title to the deceased’s estate if the policy is not nominated, assigned or issued under M.W.P. (Married women property) Act.
e) Original Policy Document
The following additional forms are called for if death occurs within three years from the date of risk or from date of revival/reinstatement.
Pli Death Claim Procedure Form
a) Claim Form B – Medical history and Medical Certificate during his/her last illness
b) Claim Form B1 – If the life assured received treatment in a hospital, Medical bills.
c) Claim form B2 – To be filled by the Medical Attendant who treated the deceased life assured before his last illness.
d) Claim Form C – Identification certificate stating burial or cremation to be completed and signed by a person of known character and responsibility
e) Claim form E – Certificate by Employer if the assured was employed person.
f) Certified copies of the First Information Report, the Post-mortem report and Police Investigation Report if death was due to accident or unnatural cause.
LIC Documents that are to be submitted while claiming policy
In case of death of insured person Claim form A is to submitted. If policy has run for 3 years or more from date or risk, then claim form no.3783A may be used.
In case of Maturity of policy, submit the discharge form no: 3825 along with original policy document atleast one month before the due date so that the payment is received before the due date of maturity claim.
In case of money back such policies, Some periodic amount is released to policy holder as Survival Benefit. The below document duly filled should be submitted for Survival benefit claim.
LIC ECS form should be submitted by policyholders those who have monthly premium option.
LIC NEFT (National Electronic Fund transfer) Form should be submitted by giving correct bank account details. So that the amount can be transfered to your account directly.
LIC Certificate of Existence should be submitted by all pension plan holders. It is mandatory to submit the Certificate of Existence for every year during entire pension receiving period.
LIC Indemnity form is applicable where the policyholder receives the cheque by authorized officer of insurance company, but the cheque is misplaced. Then the below Indemnity form should be submitted duly filled.