AD&D Lawyer

There have been conflicting legal decisions regarding what constitutes an accidental injury. For example, in past court decisions, Canadian courts have found that “death suffered as a complication of a medical procedure” is not an accident while contracting West Nile Virus resulting in paralysis is an accident.

There is a simple reason why it is so difficult to get a claim approved: claiming that an injury is accidental automatically triggers entitlement under an accidental death & dismemberment insurance policy. Insurance companies want to avoid losing money, so their policies are created to that end.

The insurance company determines if your injury aligns with their interpretation of the definitions that are outlined within your policy—and they avoid payment by arguing that your injury doesn’t qualify for entitlement because of a policy definition discrepancy.

In one case a claim was made for paraplegia based on the following definition of paraplegia, “the loss of use of both lower limbs,” and loss of use was defined as “the entire and irrecoverable loss of use beyond remedy by surgical or other means.” The accidental death & dismemberment claim was denied because the injured person’s condition did not meet these definitions, while the evidence showed that he had lost all practical and functional use of his legs, even though he still had some partial use of his legs. In this case, he was successful, although a court could have ruled otherwise.

These cases are focused both on the policy wording and the specific facts of each case, but an initial denial by the insurance company should not be taken at face value, without being further reviewed.

If your insurance company says that you do not meet the definitions of the AD&D benefit policy, contact one of our AD&D lawyers for exceptional legal services to see how we can fight their decision not to pay. If you or your loved one has been through something as tragic as losing a limb or losing their life, you deserve to have the best disability and life insurance lawyers.