Can I claim against multiple accidental death & dismemberment policies?
September 14, 2016 2:56 PM Subscribe
I was recently injured in a car accident while on vacation, in a way that makes me eligible for a "dismemberment" payout in an accidental death and dismemberment insurance policy. Through a stroke of luck (if you can call it that) it turns out I'm covered by three such policies for this incident. I have AD&D insurance through my employer, I booked the flights on a credit card that offers AD&D for the duration of the trip, and I booked my rental car through a different brand of credit card that also has an AD&D clause.
I've checked all of the small print on the policies and I can't see anything that suggests you can't claim from other similar policies at the same time (unlike healthcare and property loss insurance, which is usually exclusive as I understand it). All three policies are USA companies. This seems too good to be true - is it? How can I be sure?
I've checked all of the small print on the policies and I can't see anything that suggests you can't claim from other similar policies at the same time (unlike healthcare and property loss insurance, which is usually exclusive as I understand it). All three policies are USA companies. This seems too good to be true - is it? How can I be sure?
Call the holder of the smallest one and ask. I believe that this is fine and typical but they'll certainly tell you.
posted by Lyn Never at 3:11 PM on September 14, 2016
posted by Lyn Never at 3:11 PM on September 14, 2016
How can I be sure?
Yeah, I was about to say "Call them and ask."
I used to pay accident insurance. I suspect you can collect from all three. If you call and ask, there is no intent to defraud the company.
You could also just submit the claims and state in writing as part of your claim submission that you coincidentally have two other accident policies and if they need to do coordination of benefits, they can contact you for the info on the other two companies. If they do not contact you and they pay you, even if it is in error, you should not be liable for a fraudulent claim.
In other words, if you are honest with all three companies that you are submitting this claim to three different companies, then there is no fraud. Worst thing that happens is they coordinate benefits. But I don't think that will happen. I suspect you will get three checks.
posted by Michele in California at 3:16 PM on September 14, 2016 [2 favorites]
Yeah, I was about to say "Call them and ask."
I used to pay accident insurance. I suspect you can collect from all three. If you call and ask, there is no intent to defraud the company.
You could also just submit the claims and state in writing as part of your claim submission that you coincidentally have two other accident policies and if they need to do coordination of benefits, they can contact you for the info on the other two companies. If they do not contact you and they pay you, even if it is in error, you should not be liable for a fraudulent claim.
In other words, if you are honest with all three companies that you are submitting this claim to three different companies, then there is no fraud. Worst thing that happens is they coordinate benefits. But I don't think that will happen. I suspect you will get three checks.
posted by Michele in California at 3:16 PM on September 14, 2016 [2 favorites]
I am skeptical that none of those three policies includes a subrogation (or similar) clause. If the extent of your injuries isn't covered by a payout of any of the three, it's possible that the other two could be on the hook.
But honestly, if you have received an injury at this level, I think (broken record time) it would be a good idea for you to retain a personal injury lawyer (if you haven't already) to help make sure you get the money that is owed to you. If you lived in MN, I could give you some recommendations. I will also say that in the Venn Diagram of personal injury attorneys here, there is overlap between firms that are known to do good work for their clients and firms with cheesy Better Call Saul style billboards, so that might guide you in your decision.
posted by sparklemotion at 3:16 PM on September 14, 2016 [5 favorites]
But honestly, if you have received an injury at this level, I think (broken record time) it would be a good idea for you to retain a personal injury lawyer (if you haven't already) to help make sure you get the money that is owed to you. If you lived in MN, I could give you some recommendations. I will also say that in the Venn Diagram of personal injury attorneys here, there is overlap between firms that are known to do good work for their clients and firms with cheesy Better Call Saul style billboards, so that might guide you in your decision.
posted by sparklemotion at 3:16 PM on September 14, 2016 [5 favorites]
I am skeptical that none of those three policies includes a subrogation (or similar) clause.
Accidental injury insurance is not like normal health insurance. Although you must a) get injured in a manner covered by the policy and b) see a doctor to have medical documentation to file a claim, the benefits are not specifically intended to cover your medical bills. They are typically paid out directly to the person who was injured, not to the medical practice that treated them (unless benefits are assigned for some reason). This is completely different from, say, major medical. You absolutely can get paid more than your medical bills if you have major medical AND an accident policy. There is no coordination of benefits -- or wasn't where I worked. (All policies have specific language and how they pay out is impacted by state laws and it's really complicated.)
But, you can get accident coverage that exceeds your medical bills because the coverage compensates you for the lost limb, not for the cost of the medical care you received because of the loss.
posted by Michele in California at 3:23 PM on September 14, 2016 [1 favorite]
Accidental injury insurance is not like normal health insurance. Although you must a) get injured in a manner covered by the policy and b) see a doctor to have medical documentation to file a claim, the benefits are not specifically intended to cover your medical bills. They are typically paid out directly to the person who was injured, not to the medical practice that treated them (unless benefits are assigned for some reason). This is completely different from, say, major medical. You absolutely can get paid more than your medical bills if you have major medical AND an accident policy. There is no coordination of benefits -- or wasn't where I worked. (All policies have specific language and how they pay out is impacted by state laws and it's really complicated.)
But, you can get accident coverage that exceeds your medical bills because the coverage compensates you for the lost limb, not for the cost of the medical care you received because of the loss.
posted by Michele in California at 3:23 PM on September 14, 2016 [1 favorite]
If the policies are of significant value, I would recommend contacting a lawyer in your jurisdiction who deals with insurance matters. You will probably want to pay this person on an hourly basis, not on contingency. But there may be some reason to make claims in a particular order, or not simultaneously, or something like that, to get the largest possible recovery.
I would not trust any of the insurance companies to help with this -- if they can get you to make claims in a way that puts somebody else on the hook and gets them off, they absolutely will do that.
posted by spacewrench at 5:52 PM on September 14, 2016 [2 favorites]
I would not trust any of the insurance companies to help with this -- if they can get you to make claims in a way that puts somebody else on the hook and gets them off, they absolutely will do that.
posted by spacewrench at 5:52 PM on September 14, 2016 [2 favorites]
Also, I'm sorry that happened to you! I hope you have love and support, sending good vibes and well wishes your way.
posted by eggkeeper at 6:19 PM on September 14, 2016 [4 favorites]
posted by eggkeeper at 6:19 PM on September 14, 2016 [4 favorites]
If you aren't hiring the lawyer to represent you more broadly in this case, I do not think it is a great idea to hire a lawyer on an hourly basis. Just like insurance companies have conflict of interest, hiring a lawyer on an hourly basis introduces conflict of interest for the lawyer because he gets paid more the longer this takes to resolve. That is part of why you hire a lawyer on contingency for a case like this: a) They will not take the case if they do not feel strongly that it can be won and b) they have motive to wrap it up as quickly as possible so you both get paid.
If you are leery of calling the insurance companies, because you do not trust them, then call your state insurance department or commissioner. You can get contact info here: http://www.naic.org/state_web_map.htm
They are a consumer advocate and it should be a free call. The question you need answered is whether or not it would be fraud to submit all three claims without notifying the companies that you have other accident policies. If they tell you "no," then you should be good.
If you do want assistance for dealing with the insurance companies, a lawyer or an independent adjuster (who work on contingency typically) are possible options, though independent adjusters typically handle property damage, so might not take the case. Other than you, a lawyer or an independent adjuster, as I understand it, the only other person who can talk to the insurance company on your behalf is your insurance agent of record, which may not apply in this case, given the details of how coverage was acquired.
The insurance companies are the only people who can tell you definitively whether or not this will involve coordination of benefits. I don't think it will. But calling your state insurance department or commissioner and asking how you need to handle this should, at a minimum, protect you against accusations of fraud and that should be the only downside to filing claims with all three companies. As long as you find a way to make it clear that you aren't up to any funny business, there is nothing wrong with filing with all three policies.
Having worked in insurance, I would do that by calling them or notifying them in writing that there are other policies.
If you are retaining a lawyer anyway related to the accident, absolutely run this question past your lawyer.
Best of luck with this. Sorry you were injured.
posted by Michele in California at 11:11 AM on September 15, 2016 [2 favorites]
If you are leery of calling the insurance companies, because you do not trust them, then call your state insurance department or commissioner. You can get contact info here: http://www.naic.org/state_web_map.htm
They are a consumer advocate and it should be a free call. The question you need answered is whether or not it would be fraud to submit all three claims without notifying the companies that you have other accident policies. If they tell you "no," then you should be good.
If you do want assistance for dealing with the insurance companies, a lawyer or an independent adjuster (who work on contingency typically) are possible options, though independent adjusters typically handle property damage, so might not take the case. Other than you, a lawyer or an independent adjuster, as I understand it, the only other person who can talk to the insurance company on your behalf is your insurance agent of record, which may not apply in this case, given the details of how coverage was acquired.
The insurance companies are the only people who can tell you definitively whether or not this will involve coordination of benefits. I don't think it will. But calling your state insurance department or commissioner and asking how you need to handle this should, at a minimum, protect you against accusations of fraud and that should be the only downside to filing claims with all three companies. As long as you find a way to make it clear that you aren't up to any funny business, there is nothing wrong with filing with all three policies.
Having worked in insurance, I would do that by calling them or notifying them in writing that there are other policies.
If you are retaining a lawyer anyway related to the accident, absolutely run this question past your lawyer.
Best of luck with this. Sorry you were injured.
posted by Michele in California at 11:11 AM on September 15, 2016 [2 favorites]
I will just add briefly that the reason I don't think there is such a thing as coordination of benefits in this case is because I processed around 60,000 claims in the 5+ years I was an accident specialist and I never once had to coordinate benefits or find out if they had some competing policy or anything of the sort. Coordination of benefits was just not a thing with the work I did. I suspect this is industry wide, but I don't know that for a fact.
I worked for a large insurance company that is a household name and is rated very highly for ethics, etc.
posted by Michele in California at 1:55 PM on September 15, 2016 [1 favorite]
I worked for a large insurance company that is a household name and is rated very highly for ethics, etc.
posted by Michele in California at 1:55 PM on September 15, 2016 [1 favorite]
This thread is closed to new comments.
posted by theora55 at 3:01 PM on September 14, 2016 [1 favorite]