One of the most common questions I get from employees about life insurance is what is considered accidental death for insurance purposes? 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.
What is an Accidental Death?
Sometimes when someone dies unexpectedly, people think it should be considered an accidental death no matter how they died. After all, the person didn’t mean to die. It must have been an accident, right?
However, the insurance company doesn’t look at it that way.
Before an insurance company will consider a death to be an accidental death, they will need to know the specific cause of death. They get that information from what’s called a certified death certificate.
When you submit a claim to the insurance company, you have to include a certified death certificate with the claim to prove not only that the insured died, but also how the insured died.
When you look at a certified death certificate, it it says the insured died of carcinoma of the lung that would not be considered an accident.
The insurance company would not cover lung cancer as an accidental death because it’s an illness and not an accident.
But if the death certificate said that the person died in a car accident, then the insurance company would treat the claim as an accidental death and cover it as such.
Does Accidental Death Insurance Cover Heart Attack, Stroke, Cancer or any other Medical Condition?
If you are wondering is a heart attack, cancer or stroke considered an accidental death, the answer is no. Those are all natural causes of death due to a medical condition.
The insurance company will see whatever medical condition was determined to be the cause of death on the death certificate. Since it won’t list the word “accidental” anywhere as the cause of death, the insurance company won’t consider it an accidental death.
This would include dying from old age as well. But, people evidently don’t really die from old age. Some medical condition or disease is usually the cause.
If you don’t have a certified death certificate, here’s a state-by state-listing of how to order a death certificate if you need it.
Different Types of Accidental Death Examples
Here is a list of some examples of what would qualifies as an accidental death. Things like:
- Motor vehicle accident
- Fatal gunshot
- Work related accidents
- Hit by a car
- Other accidental deaths not listed
These are just a few examples of the types of accidental deaths.
According to the CDC, the leading cause of accidental death is motor vehicle accidents.
What is a Common Carrier Accidental Death?
Some insurance policies are only for common carrier accidents. Some insurance policies pay an additional benefit if the accidental death was a common carrier accident.
An example of a common carrier accident is one where you are a commercial passenger on a bus, plane or train. Usually this is when you buy a ticket for this transportation.
Always make sure the insurance company knows if it’s not only an accident but a common carrier accident in case that might pay an additional benefit.
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. The most common thing people wonder is suicide considered an accidental death. And it it not.
Here are some exclusions you might see:
- Intentional self-inflicted 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.
If there is any question about whether you think a a claim will be paid or not, always file a claim. Never not file a claim just because you think the claim might be denied. Always make the insurance company decide.
Don’t decide for them.
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.
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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