Monday, October 03, 2016

What is Considered Accidental Death for Insurance Purposes?


One of the more common questions I get from employees about life insurance is what is an accidental death? This question usually comes up if we are talking about an accidental death benefit rider or an accidental death & dismemberment (AD&D) policy. Let's talk about how the insurance company will determine what is and what is not an accidental death.






If It Says On The Death Certificate You Died Of An Accident, Then It's An Accidental Death


When an insured dies, the beneficiary has to file a claim with the insurance company. The insurance company will need a certified death certificate included with the claim paperwork. The death certificate should list a cause of death.

If you look at the death certificate pictured above, you'll notice the insured died of carcinoma of the lung and not due to an accident.

In this example pictured, the insurance company would not consider this death due to an accident and no accidental death benefits would be paid.

But if the death certificate said that you died in a car accident, then the insurance company would treat the claim as an accidental death.

Deaths Due To An Illness Or Old Age Are Not Accidental Deaths


If you die from any kind of illness, this is not an accidental death. So keep in mind that any die from a heart attack, cancer or some other medical condition, it won't be considered accidental by the insurance company.

This would include dying from old age as well.

Examples Of Types Of Accidental Deaths


Here are some examples of what would considered an accidental death. Things like:

  • Motor vehicle accident
  • Drowning
  • Fatal gunshot
  • Hit by a car

These are just a few examples of the types of accidental deaths.

Check Your Policy For Accidental Death Benefit Exclusions


Certain types of deaths not caused by illness would not be considered "accidental" by the insurance company.

  • Intentional injury like suicide
  • Act of war
  • Committing a felony
  • Pilot or crew member of plane that crashed

In every accidental death rider or policy that there is a list of exclusions. You'll want to be sure to check out the exclusions listed there.

What To Do If You Think The Death Was Accidental But The Insurance Company Does Not


I once had an employee tell me that his father had died and the death certificate listed the death as a heart attack. However, the circumstances of where he died and what he was doing led the employee to a different conclusion.

Evidently, his father raised cattle and he was found out in a field. The employee told me that he believed the father was rushed by one of the cattle and struck in the chest which caused his heart to stop and he died.

In order to prove that to the insurance company, he had to have the insurance company investigate the claim. An autopsy was performed and it turned out his theory was right and he was killed by one of the cattle. The cause of death was changed on the death certificate.

Then, his father's death was ruled accidental and the insurance company paid the claim that way.

Conclusion


Remember that the death certificate will be the main information that the insurance company has to determine if a death was due to an accident.

The insurance company may obviously investigate any accidental claim regardless of what the death certificate says. I once had an employee die of an accidental gunshot which was eventually ruled a suicide.

In most cases, medical examiners do a pretty good job of listing the proper cause of death on the death certificate and that's the overriding factor in determining whether an insurance company will treat a death as accidental death or not.

If you have any questions, let me know in the comments and I'll try to help.

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Michael is a champion of guaranteed issue for employees in the workplace. He's been an insurance agent since 1992 and has worked with thousands of employees.


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