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Understanding AD&D Insurance Claims

Accidental death and dismemberment insurance is intended to cover death in the case of an accident as well as dismemberment which includes the loss or loss of use of limbs, sight, hearing and speech as a result of an accident. Loss of use may also occur as a result of illness. This coverage may be found as a rider to a life insurance policy or as a benefit in a group insurance policy.

Loss of use claims can also be made in the context of private disability insurance policies. The term loss of use is broad and has been interpreted by Canadian courts as functional use (“useful use”). For example, if you are able to use your legs to walk slowly or need assistance from a walker, that could satisfy the policy requirement to have suffered the “total and irrecoverable loss” of the use of your legs.

The legal tests are complex and knowing the medical evidence and functional information required to prove entitlement is crucial. This is why having a skilled lawyer is imperative — they can help you understand your rights, negotiate with insurance companies, and ensure that you receive the full benefits you are entitled to under your policy.

Common reasons why accidental death and dismemberment claims are denied

  • Death or injury not deemed accidental
  • Death due to intoxication or substance abuse
  • The loss of use of a limb, vision or other speech (for example) is not deemed by the insurer to be “complete and irrecoverable”
  • Late claim submission
  • Exclusions specified in the policy
  • Lack of proper documentation or evidence
  • Involvement in illegal or risky activities at the time of the accident
  • Non-compliance with policy terms and conditions
  • Failure to meet policy criteria for loss of use/dismemberment
  • Death or injury not deemed accidental
  • Death due to intoxication or substance abuse
  • The loss of use of a limb, vision or other speech (for example) is not deemed by the insurer to be “complete and irrecoverable”
  • Late claim submission
  • Exclusions specified in the policy
  • Lack of proper documentation or evidence
  • Involvement in illegal or risky activities at the time of the accident
  • Non-compliance with policy terms and conditions
  • Failure to meet policy criteria for loss of use/dismemberment

Our Services

If your insurance claim has been delayed or denied, our team of experienced lawyers will be with you every step of the way, working tirelessly to secure the support you deserve.

Accidental Death And Dismemberment Claims

If your AD&D claim has been denied, our team will help you fight for the compensation you deserve after an unexpected injury or death.

Critical Illness Insurance Claims

Dealing with a critical illness is already overwhelming, and a denied claim only adds to the burden. Our lawyers will review your case, explain your rights, and advocate to ensure you get the coverage you’ve paid for.

Long Term Care Insurance Claims

Long term care insurance provides support when you or a loved one needs ongoing care. If your claim is denied or delayed, we’ll advocate for your rights to ensure you receive your coverage.

Travel Medical Insurance Claims

Unexpected medical emergencies while traveling can lead to high expenses. If your travel medical insurance claim is denied, let our legal experts fight on your behalf to recover the costs and secure the coverage you deserve.

Life Insurance Claims

Losing a loved one is hard enough. When a life insurance claim is denied, it adds unnecessary stress to an already difficult time. We’ll guide you through the claims process and work to ensure your family gets the financial support it needs.

Loan Insurance Disability Claims

Loan insurance is designed to provide financial relief if an illness or injury prevents you from working. If your claim is denied, we’ll challenge the decision and fight for the benefits you’re entitled to.

Our Lawyers give your AD & D case their full attention

If your claim for benefits under an Accidental Death and Dismemberment (AD&D) policy is disputed or denied, our experienced lawyers are ready to help. We approach each AD&D case with the precision and dedication it deserves, fully aware of the complexities these claims can involve.

The insurer’s denial letter may suggest that its conclusion is obvious and cannot be challenged. The courts are willing to consider the elements of the injury, accident or illness with a flexible, fair approach. We are aware of the relevant court decisions, and can assess your entitlement on the basis of the case law to advise whether the decision can be challenged.

We understand the significant financial and emotional toll these events can take and are here to support you through every step of the legal process.

Your insurance agent/ broker may be liable

If your claim has been denied due to errors in the insured person’s application, our experienced lawyers are ready to explore all avenues for compensation with both the insurance company and the agent the insured trusted to protect their interests. We know how to prove negligence with expert evidence and by examining the application process undertaken by the agent.

Know your rights and act promptly

It is crucial not to delay when it comes to understanding and asserting your rights. Keep in mind that there is a limited timeframe to appeal or contest an insurance claim denial. Act swiftly to protect your interests.

Let our Experienced Lawyers Help

Our team is committed to advocating on your behalf, whether that means negotiating with insurers or representing you in court, to ensure you receive the compensation needed to address the aftermath of an accident.

Bilingual Disability Lawyers with the Right Expertise to Represent You anywhere in Canada

While our offices are in Toronto, Ottawa, Hawkesbury and Waterloo, we can be by your side and on your side across Canada, handling matters in the Atlantic and Western provinces as well as Northern Ontario. There is no need for you to travel. We come to you, or we handle your case virtually.

Contact us today at 613-233-6898.

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What Our Clients Say

I couldn't be more pleased with the way my case was handled. Eliane was extremely supportive and worked diligently on my case. Her knowledge and guidance led to a pleasing outcome. Thank you to Eliane, her secretary's, reception and anyone else involved in my case. I wish you all the best in the future. Your an exceptional team. I highly recommend Eliane Lachaine.
5 stars
Helen Schutt
My personal experience in dealing with Alison at the firm was outstanding. She was always available to answer any questions or concerns I had in dealing with the insurance company. Alison was always upfront and honest with me about the results we were able to obtain. She worked hard for me and was very aggressive and no nonsense during our mediation meeting. My Ltd carrier made an strong effort to minimize the benifits I was entitled to, but Alison was having none of that. She got the results we were hoping for. I can't thank Alison enough for the help, and respect she gave me throughout the whole process.
5 stars
Lyle Fisher
My interaction with this law firm has been positive from right from the beginning exploratory conversations, which were handled with sensitivity and clarity, to the end result, which I felt was very fair. I was fully informed about possible outcomes as the process unfolded, so there were no surprises. I highly recommend the law firm of Burn Tucker Lachaine.
5 stars
Debby Clarke
I would highly recommend this firm. My lawyer’s composure, knowledge, work ethic and most of all excellent representation put me at ease during this stressful time. My most sincere thanks for a positive outcome. Thank you Alison!
5 stars
Karen T
My experience with being represented by Alison Gilmour was extremely positive. She took the time to know me as a person Alison carefully presented options and enthusiastically supported my decisions.
5 stars
Laurel Mollison
Alison and her team made this process extremely stress free and would highly recommend them to anyone who needs a disability lawyer. She took care of all the works so I could focus on my health.
5 stars
Kaitlynn Friesen
Forever grateful for the exceptional help, care and knowledge from the team at Burn Tucker Lachaine. Highly recommend to contact for any personal injury journey.
5 stars
Kayla P
Had a great experience with the team at Burn Tucker Lachaîne everyone is very pleasant and thoughtful, Colleen great work, definitely will recommend to family and friends.
5 stars
Lindamir Schuchardt
This team of professionals were able to assist me and I would highly recommend them.
5 stars
Lori Toffolo

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