Many people whose accidental death and dismemberment (AD&D) have been denied feel that they are out of options. You filed for your benefits, the petition was denied, and the insurance company has all the power and resources, so it seems that there is nothing you can do.
However, many people don’t realize that they have the right to appeal an AD&D denial in almost every case. It is important to have some understanding of the process.
What type of insurance do you have?
Most people have employee-provided life insurance, which is regulated by the Employment Retirement Security Act of 1974 (ERISA). ERISA carries numerous regulations and safeguards to protect employees from bad-faith insurance claim denials, so there are rules that insurance carriers must follow.
The first step is to talk with an attorney
If your claim has been denied, the first thing to do, really, is talk with an attorney experienced in life insurance matters, who can help protect your interests through the appeals process.
The second step is to appeal with the insurance carrier
After talking with a lawyer, the second step is to work through the appeals process internally with the insurance company. This is called an administrative appeal. The insurance carrier is required to give you its reasoning for the denial, along with the date of the denial. This document can help you address the specific problems in the initial claim and make your best case for appeal.
Although there are strict rules under ERISA for how an insurance company handles its internal appeals processes, many claims are still denied at this stage. However, in most cases, ERISA demands that policyholders work through the administrative appeals process with the insurance carrier before filing a lawsuit.
The third step is litigation
Assuming the claim is still denied upon the administrative appeal, the next step is to file a lawsuit against the insurance company in federal court. This is like any other civil claim, where evidence and testimony are recorded to establish that the denial was in bad faith or at least unwarranted.
Time is of the essence
When it comes to insurance denials and appeals, the clock is always running. There are strict timelines for the initial claim filing, the administrative appeal and any subsequent lawsuit. Make sure you are on top of the timelines because, if you fail to file anything on top, you will almost certainly lose the right to continue with your claim.