As the result of a horrific accident, a man in San Jacinto, CA lost his wife. Because her sad and untimely death was accidental, our client filed a claim for accidental death benefits under his wife’s life insurance policy. Colonial Penn Life Insurance Company denied the claim for reasons that were objectively untrue. As such, Dabdoub Law Firm had to highlight undisputed facts and demand benefits on our client’s behalf.
Details of Our Client’s Loss
Our client’s wife suffered a compound fracture and massive blood loss following a fall. She was rushed to the hospital and nearly died in the ambulance. Doctors decided to amputate her leg. She barely survived the operation and passed away soon after.
Ultimately, our client’s wife never recovered from her accident and died as a direct result of her fall. As such, our client should have been entitled to the accidental death benefits of his wife’s life insurance policy. In a disappointing turn of events, however, Colonial denied his claim. The insurance company claimed our client’s loss was the direct result of illness and disease, which is blatantly false. If our client’s wife had not sustained an accident, she would still be alive today.
Dabdoub Law Firm Highlights Facts and Legal Precedents
When our client contacted us, we reminded Colonial that the policy in question allows for benefits if an insured person dies as a direct result of accidental bodily injury. We clearly linked our client’s loss to his wife’s accident and contested Colonial’s position. We also emphasized that the law prohibits insurance companies from separating the complications of treatments from the accidents that caused them. Similarly, we cited a precedent that distinguishes medical treatments due to accidents from treatments due to illnesses. Once we had laid out the facts and legalities of our client’s case, we demanded payment within 21 days.
Fortunately, Colonial complied with our demand.
Our Lawyers Specialize in Disability Insurance Claims
Because our law firm has always focused only on disability insurance, our lawyers are experts in legal representation for disability insurance benefits.
That meansour disability lawyers have:
- Won several major disability lawsuits that help make laws better for disability claimants.
- Experience fightingmajor insurance companies, likeUNUM,Hartford,MetLife,CIGNA,Prudential, and more.
- Successfully represented hundreds of clients and wonmillions of dollars in disability benefits.
Because federal law applies to most disability insurance claims, we can help clientsacross the country.
Disability insurance companies have lawyers. You should, too. Call Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
Call us at (800) 969-0488 or contact us online for a free consultation with a disability attorney. No fees or costs until you get paid.
FAQs
Insurers may deny an AD&D claim by basing allegations on weak or nonexistent evidence, or that the death was not accidental. An insurer may refuse to pay benefits when a death caused by an accident does not immediately follow the accident, but takes weeks or months to occur.
What to do if a life insurance company denies your claim? ›
A Through Appeal Increases the Chances of Winning Your Claim
Explaining to your insurance company why it made a mistake in denying your claim is the preferred course to take. But when your insurance company will not listen, then filing suit becomes the only alternative.
Why would a life insurance company deny a beneficiary their benefits? ›
The insurer might request medical records and other documents to evaluate them for any evidence of material misrepresentation on the life insurance application. If your insurer finds evidence of material misrepresentation, the policy could be voided and your beneficiary would not receive a death benefit.
What is the lawsuit against Colonial Penn? ›
As the result of a horrific accident, a man in San Jacinto, CA lost his wife. Because her sad and untimely death was accidental, our client filed a claim for accidental death benefits under his wife's life insurance policy. Colonial Penn Life Insurance Company denied the claim for reasons that were objectively untrue.
What accidental death does not cover? ›
Accidents that occur while a person is engaged in illegal activities or under the influence of drugs and alcohol will probably not be covered. Similarly, if accidents occur during the practice of a dangerous hobby such as ice fishing or during travel through a war zone, there is a good chance AD&D may not cover them.
What are the exclusions for accidental death policy? ›
Accidental death policy exclusions
Some life insurance policies, known as accidental death policies, only provide coverage for the insured if they die due to an accident. Causes of death related to illness, medical issues or chronic health conditions are not covered.
What disqualifies life insurance payout? ›
Life insurance may not pay out if the policy expires, premiums aren't paid, or there are false statements on the application. Other reasons include death from illegal activities, suicide, or homicide, with insurers investigating claims thoroughly.
Can a life insurance beneficiary refuse payment? ›
In some cases, though, your beneficiary might not be able to receive the funds. There are a few reasons why this typically happens: They've died before you or they might refuse the payout, which is called disclaiming the benefit.
How to successfully appeal an insurance denial? ›
Steps to Appeal a Health Insurance Claim Denial
- Step 1: Find Out Why Your Claim Was Denied. ...
- Step 2: Call Your Insurance Provider. ...
- Step 3: Call Your Doctor's Office. ...
- Step 4: Collect the Right Paperwork. ...
- Step 5: Submit an Internal Appeal. ...
- Step 6: Wait For An Answer. ...
- Step 7: Submit an External Review. ...
- Review Your Plan Coverage.
Why would a death benefit be denied? ›
But it's important to be aware that there are a few instances where life insurance won't pay out. Top reasons life insurance won't pay out may be because the policyholder lied on their application, their death was the result of suicide, or they passed away during the waiting period.
Insurers rarely deny life insurance claims, but it can happen in cases involving excluded causes of death, insurance fraud, or policy lapse. Here's why some claims are rejected and how to appeal the decision.
What is the time limit for death claims in life insurance? ›
The Insurance Regulatory and Development Authority of India (IRDAI) mandates insurance companies to settle death claims within 30 days. The guideline applies to all cases where no investigation into the death is required. If there is an investigation, the timeline extends to a maximum of 120 days.
Can Colonial Penn be trusted? ›
Although Colonial Penn is a stable insurer with an A- financial strength rating from AM Best,* the company received mixed marks in other areas. Part of this is due to limited offerings and a focus on no-exam policies that result in higher policyholder premiums.
What are negatives with a Colonial Penn life insurance? ›
Pros and Cons of Colonial Penn Insurance
Pros | Cons |
---|
No-exam insurance plans available for people who don't qualify for standard policies | Maximum coverage amount is $50,000 |
30-day refund period where you can cancel for a full refund | Strict age limits for plans |
1 more row
Does Colonial Penn ever pay out? ›
Colonial Penn offers two whole life insurance policies. Both policies offer a lump-sum death benefit payout, accumulating cash value the policy owner can access while the insured is still living. As with all policies, the death benefit payout will be reduced if the amount borrowed is not repaid.
What conditions must be met for an accidental death benefit to be paid? ›
In the case of a fatal accident, death usually must occur within a period specified in the policy. Some policies' accidental death benefits may also cover dismemberment—total or partial loss of limbs—burns, instances of paralysis, and other similar cases.
What qualifies under accidental death for insurance? ›
AD&D insurance will cover only deaths and injuries from accidents—not natural causes or illnesses. Not heart attacks or strokes. Policies typically cover death or injuries from accidents at work, home and while traveling.
What is one of the most common reasons for a claim being rejected by an insurance company? ›
Process Errors
- The claim has missing or incorrect information. Whether by accident or intentionally, medical billing and coding errors are common reasons that claims are rejected or denied. ...
- The claim was not filed in a timely manner. ...
- Failure to respond to communication. ...
- Policy cancelled for lack of premium payment.