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AD&D insurance

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R

rissasue

Guest
My sister died in 1998 in auto accident. Brother-in-law contact her insurance rep., at old job, was told no insurance. A year later we find out she had coverage. Filed and took them 9 months to decide to pay, with no interest paid in addition to policy amount. But they refuse to pay AD&D portion, saying she wasn't covered since she left job and her next payment would have been due 18 days prior to death, so coverage stopped then. The insurance policy (copy was sent to me) states "Termination of Personal Insurance"
Coverage for any Insured will end of the first premium due date on which the Insured is no longer eligible; subject, however, to any applicable "Conversion Privilege" contained in this policy.
But their Benefits Book under the dependent only portion, states "No conversion privilege is available for the AD&D portion of this coverage...."
They are using this to say they don't have to pay. Is there any hope to make them pay, since it is implied there is a conversion privilege in the policy, and they have admitted in writing there should not be a reference to a right not applicable to this policy?
This would be under the Arkansas State Law, as that is where the policy was delivered.

Thanks for any help.
 


ALawyer

Senior Member
While conversion privileges are generally NOT applicable to AD&D coverages, the issue is not whether there was a conversion right, but when was the policy for her paid thru that is, when did it run out. This may depend on the date of premuim payment by the EMPLOYER if it is a Group Policy. It may also be a case of intentional misconduct / bad faith by the insuarnce company -- and do NOT take their word for it. Read the section on Bad Faith, IN FULL, on FreeAdvice. Then go to a lawyer in ARKANSAS who knows insurance for advice and can fight for you. And make sure you get and give the lawyer the full Group Policy, the Summary Plan description, the coverage certificates, and the employee handbook as they were in effect at the date of death. If it is a national company it may not only be Ark. law that applies.


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This is intended as general information only and NOT LEGAL ADVICE. You are not my client, and I have no obligation of any kind to you. To retain a lawyer, go to http://AttorneyPages.com
 

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