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

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

By your side,
and on your side™


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