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3 things to know when appealing an AD&D claim denial

On Behalf of | Mar 6, 2024 | accidental death and dismemberment (AD&D)

Accidental Death and Disability (AD&D) insurance provides beneficiaries with a financial safety net in the tragic event of a policyholder’s accidental death or loss of a specific body part. If your employer provided these benefits, the Federal Employee Retirement Income Security Act (ERISA) likely applies. Although there are many layers of protection, not all claims are straightforward, and denials can occur for various reasons.

You do not have to accept a denial: Basics of the appeals process

When an insurer denies an AD&D claim, beneficiaries have the right to appeal the decision. An appeal is a formal request to reconsider the claim based on additional information or arguments that may affect the outcome. The process generally unfolds as follows:

  1. Review the document. The denial generally comes in the form of a letter. The first step is to review the letter for information on the reason for the denial. With AD&D claims, the denial is often due to an exclusion. Take some time to review this information and attempt to understand their reasons for denial.
  2. Check for missing info. Identify any missing information or evidence outlined within the letter to include within the appeal.  When a claim of this nature is denied, you have the right to and should obtain a copy of the insurer’s claim file, which includes (or should) all the information it used to make its decision to deny your claim.  You should ask for this claim file as soon as you can.
  3. Gather additional evidence. When putting together the appeal, include any additional evidence and documentation is available to support the claim that was not included in the original application.

Before submitting an appeal, it is essential to understand the policy’s terms and the specific reasons for the denial. Medical records, and accident reports,  often serve as important evidence to help build your appeal. Even if the policy sites an exclusion, it is still possible to build a successful appeal.