Accidental Death And Dismemberment Payouts

Accidental Death And Dismemberment (AD&D)

Life Insurance Policies often have two components. There is usually a “basic life” component and an AD&D component. In many cases the life insurance company will pay the basic death benefit; but they will deny the accidental death and dismemberment payout. Usually the AD&D policy is larger so the life insurance company has a greater incentive to find a way to deny the claim or rescind the policy for misrepresentation on the policy application. DiGeorge Life Insurance Law has great expertise in winning denied AD&D claims. We handle many cases where the cause of death is murder or homicide. Many times the police and coroner incorrectly label homicides as an accidental drug overdose. We see many cases where someone was intentionally given fentanyl to kill them. All denied accidental death and dismemberment claims should be closely examined by an experienced life insurance policy lawyer.

Now A Little Info About FEGLI Cases

FEGLI stands for Federal Employees Group Life Insurance, and is a program that provides federal employees with group life insurance, in fact, it is the largest group life program in the world, comprised of more than four million members. Not only does it insure federal employees, but it insures retirees as well as their family members. The Office of Personnel Management oversees it, but the life insurance coverage is provided by MetLife.

FEGLI Beneficiary

Unlike other life insurance, the employee must name a beneficiary to receive the death benefit. Under FEGLI, the beneficiary named in the policy is the only valid recipient of the policy proceeds.

With respect to a FEGLI beneficiary change, what do I do if there is a beneficiary dispute?

If an employee wants to change the beneficiary, a FEGLI Beneficiary Change Form must be signed in front of 2 witnesses. It must be approved by OPM which is the Office of Personnel Management before the death of the employee. Issues arise as to whether the beneficiary change is valid both when OPM receives the form before death, as well as after death.

How do I handle a FEGLI Interpleader?

If there is a beneficiary dispute, the insurance company may opt for an interpleader, in which the money often goes to the court, and the competing beneficiaries have to fight it out.

If there was no beneficiary on file for a FEGLI claim, who gets the money?

If no beneficiary was designated, the money is paid out to the widow. If the widow is deceased, it goes to the children. If no children or the children are deceased, it goes to the parents. If the parents are deceased, the money goes to the executor/administrator of the estate. If there are none, the next of kin would get the money.

If there was a divorce, and I am in a community property state, who gets the money?

FEGLIA which stands for Federal Employees Group Life Insurance Act is a federal law, and trumps any state community property issue, thus, the money is distributed according to the preceding section. For example, in a recent case the decedent named his fist wife as the sole primary beneficiary of $125,000 in life insurance proceeds. He then divorced her and married Hillman. The decedent never changed the beneficiary. After his death, both the surviving spouse and the ex-spouse filed claims.

The case went through years of litigation and was finally heard in the high court. The Supreme Court stated that it did not matter what the state law said, the federal law controlling the case prevailed, and the ex-wife correctly received the death benefit. Writing for the majority, Justice Sotomayor opined, “where a beneficiary has been duly named, the insurance proceeds she is owed under FEGLIA cannot be allocated to another person by operation of state law.”

If there is a change of beneficiary for a FEGLI policy by someone other than the employee/insured, who gets the money?

If some 3rd party with a POA Power of Attorney changes the beneficiary, FEGLIA will not deem it as valid, so you’ll want to call us if there is any beneficiary dispute.

What happens if the insurance premiums for a FEGLI policy aren’t paid?

If the FEGLI insurance premiums aren’t paid, the coverage may be terminated. The beneficiary that was designated is canceled 31 days after the coverage stops. If the federal employee reinstates the policy, a fresh beneficiary form needs to be filled out. Our lawyers can investigate these situations, so you’ll want to give us a call.

Typical reasons FEGLI AD&D Claims Are Denied Include:

• Suicide
• Self-Inflicted Injury
• Sickness
• DUI or Comparable
• Alcohol exclusion
• Illegal drugs
• Drugs administered yourself

• Qualified domestic relations orders
• Former spouses
• Death of a spouse
• Death of a dependent

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