ERISA Experience You Can Rely On.

How to appeal a denied accidental death & dismemberment (AD&D) claim

On Behalf of | Feb 13, 2023 | accidental death and dismemberment (AD&D)

A claim on accidental death & dismemberment (AD&D) insurance coverage usually comes at one of the most desperate times in the claimant’s life. Either your spouse or other loved one has died in a terrible accident, or you have suffered an accidental dismemberment, defined as the loss of a body part or loss of that part’s function. Due to the accident, there could be little or no income coming into the home.

AD&D insurance can be a financial lifeline in difficult times, but the insurance company must first approve your claim. They often don’t. Fortunately, you have the right to appeal, but the process is complex and can be very challenging for someone unfamiliar with the law. Here is a broad overview of what to expect.

The administrative appeal

Before you can appeal your denied claim to court, the applicable federal law, known as ERISA, requires you to appeal internally. That means you must file an administrative appeal with the insurance company. ERISA lays out guidelines for how administrative appeals of AD&D claim denials work. But beyond that, each insurance company has its own procedures. You and your attorney need to become familiar with those procedures so your appeal is not dismissed on a technicality.

If the administrative appeal fails to overturn your claim denial, your case could end up in court. Litigation is unusual, but it should always be an option because it is one of the biggest pieces of leverage you have against the insurance company. And the AD&D funds are often significant enough to make a successful trial worthwhile.