Accidental death and dismemberment insurance question

[tiredwifeinMO]

What is the name of your state (only U.S. law)? Missouri

I wasn't sure which forum to ask my question in. I have carried AD&D insurance on myself and my family for over 10yrs. My husband is insured for 5X his salary I believe. He was injured in a work place accident. He did not die or loose any limbs but has lost partial use of some and is now disabled. We recently just filed for disability and is not approved yet. At the time of the accident I called my employer and requested a claim form. Most questions couldn't be answered at that time. Its been a yr and there is a 365 day time limit to make a claim. I called my employer today and they had to call Hartford, the insurance policy holder to see if I could even make a claim. My employer explained the unusual situation and I will be receiving my claim form tomorrow.

Does anyone know how the process works? Right now the priority is getting the claim form returned to my employer who will forward it to the policy holder to beat the 365 day limit to file. Then I will send all the medical and workers comp info in by fed ex.

Does anyone know how AD&D works with loss of use as opposed to loss of the limb? I don't think I've ever been given anything on my policy, other than confirmation he was insured at 5X his salary.

 

[justalayman]

You would have to read the policy to determine what, if anything, is covered.

 

[Betty]

Agree, all this should be covered in the policy provisions. We can't read
the policy so there is no way for us to know.

Accidental Death & Dismemberment "generally" pays if the insured dies in an accident, loses his or her sight, or loses two limbs as the result of an accident. However, every policy is not the same so the policy will have to be read.

 

[tiredwifeinMO]

Thank you for your replies. I know not having the policy makes it impossible to really answer. I will go to my HR dept today an request a copy. I will hopfully be able to post more details this evening.

 

[tiredwifeinMO]

I got a copy of my policy. There is a section that states " if determination of disability is required" and goes on to to give their definition of disability and how much time they are allowed to make a determination.

I did call the carrier's customer service line to ask questions. She wouldn't answer them. She did give me the name of the person assigned and the claim number and offered to forward my info for them to call me. They should have the returned claim form and medical and accident info now. Should I have them call me? What questions should I ask?... other than the obvious - Is he covered for accident that left him permanently disabled?

 

[OHRoadwarrior]

It sounds like you found nothing indicating it covers anything more than death or dismemberment. That clause likely refers to proof of death or dismemberment.

 

[ecmst12]

The policy should describe EXACTLY what perils/situations are covered.

 

[Betty]

Agree, everything should be in the policy provisions - what is covered,
their definition of disability etc. It seems they are working on the
case.

 

[tiredwifeinMO]

Thank you for taking time to reply. The policy seems so vague and doesn't really say much. If they do pay the claim it would be nice. If not, we will manage. If denied they will let me know the reason for denial.

Thanks again for taking time to respond.

 

[OHRoadwarrior]

Thank you for taking time to reply. The policy seems so vague and doesn't really say much. If they do pay the claim it would be nice. If not, we will manage. If denied they will let me know the reason for denial.

Thanks again for taking time to respond.

Good luck.

 

[Betty]

Thank you for taking time to reply. The policy seems so vague and doesn't really say much. If they do pay the claim it would be nice. If not, we will manage. If denied they will let me know the reason for denial.

Thanks again for taking time to respond.

You're welcome.

It seems they are working on the case & will get back to you with a decision. Good luck to you. They have to go by the policy provisions.