Delay or Denial Of Your Accidental Dismemberment Policy Claim

Many accidental death policies also include coverage for accidental dismemberment, such as the loss of a limb, loss of special senses like vision, hearing, or speech, or paralysis as a result of an accident.

Most policies will have a schedule of benefits based on the type of loss. Many dismemberment policies require the loss of use of two or more limbs, the loss of sight in both eyes, or paralysis in all limbs to qualify for full benefits. Partial benefits can be payable for lesser losses, such as the loss of vision in one eye. Each policy is different.

Reasons for Claims Delay or Denial of Accidental Dismemberment Benefits

Many dismemberment claims are denied for the same reasons as a life insurance claim. Claims can be denied based on the following coverage defenses:

• The policyholder failed to pay premiums.
• The employer failed to remit the premiums or made a mistake in offering coverage.
• The policy lapsed.
• The policyholder failed to reinstate the policy.
• The policyholder made misrepresentations on the policy application.
• The policyholder didn’t provide complete information on the insurance policy application.
• The policyholder didn’t provide the insurability form.
• The policyholder was terminated and didn’t have coverage.
• The policyholder’s employment status changed so there was no coverage.
• The policyholder didn’t file a claim timely.

Insurance Carrier’s Claims to Policy Exclusions 

Insurance carriers also claim they don’t have to pay dismemberment benefits based on policy exclusions that include a claim that:

• The insured’s dismemberment, loss of special senses, or paralysis was due to sickness.
• The insured’s dismemberment, loss of special senses, or paralysis was not accidental.
• The insured’s dismemberment, loss of special senses, or paralysis was accidental but was contributed to by a sickness.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of intoxication.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of taking prescription drugs that were not prescribed by a doctor.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of taking illegal drugs.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of autoerotic asphyxiation.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of an assault or murder.
• The insured’s dismemberment, loss of special senses, or paralysis was the result of violating the law or participating in a misdemeanor or felony.

Sound familiar? Heard it from the life insurance carrier? Now it’s time to get answers. Was the carrier right or wrong? How do I get them to pay benefits quickly? How do I appeal? Is it time to sue them?

Every case is fact-specific and policy-specific. There are no cookie-cutter answers, and that is why it is crucial that you consult with an experienced accidental dismemberment insurance benefits attorney.

We will:

• Listen to you.
• Review the policy.
• Review all important documents.
• Review the carrier’s letters.
• Answer all of your questions.
• Explain all of your options.
• Explain what it will cost.

No Legal Fees Unless We Win Your Case

Our fee is simple. We work on a contingency fee basis, which means we don’t get paid unless we collect the life insurance benefits that are delayed or denied.

We charge a fee that we all agree on when we are hired to represent you. The fee is flexible and is based on whether the claim is delayed or denied and how medically or legally complex the case might be.

We guarantee you will be comfortable with the fee.

Don’t let the accidental dismemberment insurance company rob you of your peace of mind and financial security. Call today for a complimentary consultation at 727-894-3188.