What to Look for in ERISA Accidental Death and Dismemberment Plans?

The Employee Retirement Income Security Act (ERISA) is a federal law that regulates the vast majority of group employee benefit plans. It covers disability insurance plans and life insurance plans offered by private-sector employers. ERISA also covers accidental death and dismemberment (AD&D) policies. However, most people do not know about ERISA or how it impacts their AD&D insurance plans. 

If you want to learn more about how to evaluate an AD&D plan, then take a moment to review this article. For more specific advice, contact a qualified ERISA attorney at the Peace Law Firm today. We can give you advice tailored to your unique situation. 

How to Understand Your AD&D plan

Unfortunately, few people think about their insurance plans until they make a request for benefits or receive a denial of benefits. But taking a few minutes to thoroughly understand your plan can save you from disappointment down the road.

Step #1: Obtain and Review a Complete Copy of Your AD&D Plan 

To get started, request a complete copy of your AD&D policy. This document is not always easy to obtain. Most insurance companies provide only plan summaries or basic information on their website to employees. Although summaries and websites can help you understand some of the benefits available to you, they often exclude most of the pivotal information. Specific details that a complete copy of your policy will feature include:

What to Look for in ERISA Accidental Death and Dismemberment Plans?
  • Definitions. As the old saying goes, “the devil is in the details.” By knowing what every term in your AD&D policy documents means, you can understand the full scope of your coverage and avoid unwelcome surprises.  
  • Claim Procedures. The complete copy of your AD&D policy will discuss how you file a claim, how the company processes your claim, and how you can appeal your claim. These details are essential for understanding your rights and responsibilities. 
  • Exclusions. Virtually all AD&D plans exclude certain causes of death and injury. The most common exclusion is suicide, but more obscure exclusions are often in AD&D plans, like deaths from a “high-risk” hobby.

When reading through your AD&D plan documents, do not assume that common words possess their normal meaning. Even seemingly straightforward terms like “disfigurement” and “sickness” may have specific definitions that include only certain situations. Similarly, your plan’s definition of a “high-risk” hobby may encompass fairly safe activities like snowboarding and jet skiing. If the language is too confusing or convoluted, reach out to an experienced attorney who can explain what your policy does and does not cover. 

Step #2: Select and Verify Your Coverage

Once you understand the provisions of your plan, learn about your coverage. Some employers will provide you with a basic level of AD&D coverage without discussing it with you. Others will allow you to choose the exact amount of coverage you want. Whatever the case, make sure you understand your coverage. In addition, learn whether your AD&D plan’s coverage extends to your spouse or other family members. Some AD&D plans only cover the policyholder, while others extend full or partial coverage to family members. Once you understand your coverage and how it applies to family members, obtain written verification of your coverage details from the plan provider. This helps you confirm that you are paying the right premiums for your policy. It also serves as a valuable piece of evidence if your claims provider makes a mistake and limits or denies your claim.

Step #3: Ask Your Insurance Company for a Complete Administrative Record

Your administrative record contains all the information your insurance company considers when evaluating your claims. By obtaining this record, you can learn more about why your plan administrator denied your claim. If you end up appealing a denial of benefits, then your administrative record will certainly be a key piece of evidence. 

We Can Help If You Have Questions About an ERISA Accidental Death and Dismemberment Plan 

Now that you have an idea of what to look for in an ERISA accidental death and dismemberment plan, you can avoid most of the common mistakes made by claimants. However, insurance plans are overwhelmingly complex. Insurance companies are experts at leveraging that complexity to deny insurance claims and leave ordinary people out in the cold. With an experienced ERISA lawyer on your side, you can turn the tables on the insurance companies and obtain the benefits you deserve. 

With John Peace and the Peace Law Firm, you can start securing your financial future today. Since 2002, the Peace Law Firm has helped clients obtain victories against insurance companies. We have many years of experience working with ERISA AD&D claims and can help you fight for your benefits. Still not sure if you need an attorney? Don’t worry. We offer free initial consultations for all potential clients. Set up your consultation today by calling us or reaching out to us online

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