Accidental Death & Dismemberment
(AD&D) Claims in Michigan
Accidental death and dismemberment (AD&D) insurance is meant to provide benefits if the insured dies or loses a limb in an accident. But insurers routinely deny valid claims by recharacterizing accidents as illness, or invoking policy exclusions to avoid paying.
JuneLaw will help you get the benefits you deserve.
Families may receive a condolence letter one day and a denial of benefits the next.
What is Accidental Death & Dismemberment (AD&D) Insurance?
AD&D insurance pays benefits when the insured dies or loses a limb (or other covered body part, including loss of sight, hearing, or speech) as the result of an accident, not from illness or natural causes. Different policies will have their own definitions as to what qualifies as dismemberment, and what benefits may be obtained.
AD&D is most commonly provided through an employer as part of a benefits package; the covered employee may not even know they have it.
How is coverage often denied?
Insurance companies often contest these claims by re-characterizing an accident as being caused by an underlying illness. For example, a death in a car accident may be denied on the basis that a pre-existing heart condition contributed to it. This recharacterization is a primary denial tactic.
Or, you may be told that there are specific circumstances written into the policy that void coverage. These may include intoxication, drug use, or engaging in a “hazardous activity.” Insurers invoke these even when the connection to the accident is tenuous. Even when the exclusion is not the primary cause of death, insurers may argue that its presence alone disqualifies the claim.
Why Your Employer Matters (and something called ERISA)
Your employer is private
If you are employed by a private company, then your insurance is subject to the Employee Retirement Income Security Act of 1974, commonly known as ERISA (see ERISA: How it Impacts Your Claim). ERISA is a massive and complicated law that oversees how many different types of insurance plans are established and communicated to employees. Importantly, it requires that plan participants are able to appeal denied claims.
JuneLaw’s depth in ERISA provides a big advantage when it comes to appealing denied claims.
Your employer is not private
If you are employed by a non-private employer, such as the government or a church, then ERISA does not apply, and instead there are specific laws set up by your state. Each state has unique procedures and it is important for your attorney to know what they are.
The JuneLaw team has extensive experience dealing with insurance law in the state of Michigan.
If your AD&D insurance is through a private employer, ERISA governs your claim. The appeal you file with the insurer is your only opportunity to submit evidence. Once denied and the appeal is exhausted, the record is locked — no new evidence can be introduced in court. Contact JuneLaw before filing your appeal.
These types of disputes become complex legal battles where insurers leverage their advantages under ERISA.
At JuneLaw, we leverage our deep understanding of the law and experience litigating these types of cases to bring the best possible results.
The JuneLaw Team