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3 things you need to know about appealing your accidental death and dismemberment claim denial

On Behalf of | Mar 16, 2022 | accidental death and dismemberment (AD&D)

If you are like most people applying for benefits from an employer-provided insurance carrier, you might have experienced a denial of your claim. These claims are quite significant for the policyholders, making the frequency of denials quite alarming. You obtained accidental death and dismemberment (ADD&D) insurance for a reason, and when it’s time to make a claim, you most likely really need that money.

If you have had your AD&D claim denied, you need to understand what the next steps are. Can you just bring a lawsuit? Are there other steps you can take to get the money you need?

The initial filing

The first step and the most effective method of getting your claim approved happens long before any litigation process. Whenever possible, you should be looking at the initial filing of your claim first. This is the place where, if handled properly, you can get a valid claim approved by submitting the required paperwork, medical reports and forms.

Can you take your case to court if your claim was denied?

The short answer is, no. At least not yet.

Under ERISA law (The Employee Retirement Income Security Act), before you can file suit of your denial in civil court, you need to go through the process of appealing your case internally through an administrative appeal.

The administrative appeal

When you are filing an administrative appeal, make sure you:

  1. Obtain the reasons for the claim denial: The first part of the appeals process involves obtaining an explanation of your claim denial from the insurance company. This is something the insurance company is required to give you to help you understand why your claim was denied, which is extremely valuable in your administrative appeal.
  2. Understand your insurance company’s appeal procedure: When you get that denial information, you should also learn about the appeals process within your specific insurance company. Although ERISA has guidelines regulating the appeals process, your insurance company will have its own specific procedures within those guidelines that you will need to follow.
  3. File your appeal carefully: There are time limits and strict requirements for how to file your appeal. Make sure you get everything in order and get the written appeal  to your insurance company on time.

To increase your chances of obtaining your benefits it is beneficial to work with an experienced attorney who knows the administrative appeals process well and can protect your rights every step of the way.

Obtaining AD&D benefits can be a challenging, complicated process, with a lot at stake. There is not time for making errors or small oversights. Do everything you can to make sure everything is in order, to get the benefits you need.