Why Accidental Death Insurance Claims Get Denied

Life insurance companies make a habit of denying most accidental death benefit claims. Accidental death benefit insurance provides a cash payment to the insured’s beneficiary when the insured dies, within a predefined timeframe, from an accident. An accident can be anything from a car crash to falling down. Once a claim has been filed the insurance company’s Claims department opens an investigation. This is standard practice for all accidental death benefit claims. The Claims department will investigate the cause of death. They will review the Certified Death Certificate, the Medical Examiner’s Report and the complete health records of the deceased. Logic would dictate that the insurer would investigate the insured before they offer the coverage and accept premium payments, but they don’t. Every claim is investigated.

Accidental death policies have many exclusions and always have the stipulation that the death must be the result of an accident. What surprises most beneficiaries of accidental death benefit policies is that even when the Certified Death Certificate states the cause of death as “accidental”, the claim will likely be denied. What accompanies the death certificate is the Medical Report. This identifies the cause of death in medical terms. While death from falling may be an accident on the Death Certificate, it may be defined as an aneurism on the Medical Report. The denial of most accidental death claims is due to a common link between the health history of the deceased and the Medical Examiner’s Report.

Once an accidental death claim is made the investigator immediately starts looking for ways to link the medical cause of death to a medical condition that existed while the insured was alive – even if the insured did not know one existed. The unfairness of this post-death investigation is that it is rarely conclusive, but it’s used as the common reason for a claim denial. It is like the proverbial question of which came first, the chicken or the egg. The insurance companies take advantage of the fact that it is impossible to prove whether a past event or the accident triggered a bodily reaction that ended in death. Their approach seems to be that if the beneficiary cannot disprove something, then how can they argue the matter? Thereby, most accidental death benefit claims are denied.

Naturally, insurance companies will argue that they never intend to deny valid accidental death claims. But when they offer one million dollars of coverage for only eight dollars per month, they cannot afford to pay very many claims or they will be out of business. Our success in getting accidental death benefit claims paid is due, in large part, to our ability to anticipate the likely reasons a claim will be denied and then to eliminate those possibilities before they happen. If you have an accidental death benefit claim we suggest you be as prepared as possible before you submit your claim so you won’t be denied the money your loved-one intended you to have.