BASIC & AD & D INSURANCE QUESTION.....(Serious Inquiries Only)

TheShotDoctor · Jan 29, 2008

As Many Of You Know, My Mother Passed Away Back On December 10, 2007.....So It's Been 7 Weeks Now, and I'm Still Going Round & Round w/ PRUDENTIAL. I Have A Legit Question & Those Dumbass People Cannot Answer It. I Went To The HR Department At Her Place Of Employment Today & Still NO ANSWERS. My Time To "Push" This Issue Is Starting To Become Limited, So Any Help Would Be Much Appreciated.

If You Are An Attorney Or Insurance Salesman...Please Reply.

Thanks In Advance
--MR. NW--

texansfan · Jan 29, 2008

Just ask. I'm sure others have been involved with matters such as yours.

TheShotDoctor · Jan 29, 2008

OK................Here's The Deal

When My Mother Passed Away In Her Sleep, I Was Very, Very Shocked. Even Though She Had Been Very Sick, Due To A Bout w/ Pancreatitis and Lost 57 LBS....She Was Improving. She Was Beginning To Start Moving Around Again and The Doctors Had Said She Had Beat The Pancreatitis....Now She Had To Regain Her Appetite, As She Was Eating Very, Very Little. Actually Just Enough To Survive. My 10 Year Old Daughter Spent The Day W/ Her On Saturday. They Went For A Walk, Colored Pictured, Watched Christmas Movies, Wrapped Gifts, Etc. She Even Spent The Night W/ My Mom. I Picked Up My Daughter Around Lunch On Sunday. And Then My Mom Died In Her Sleep On Sunday Night. I Found This Very Strange, and Requested An Autopsy. Once The Autopy Came Back, It Stated That My Mother Passed Away From.."Pulmonary Aspiration Of Gastric Contents."
I Was The 100% Beneficiary Of Her Life Insurance, So After Receiving The Death Certificates, and Claim Forms, I Filled Everything Out & Mailed Them Back In. So, Today The Insurance Company Calls Me & Says The The Insurance Is Going To Pay...
1 X Her Base Salary
5 X Her Annual Salary
I Told Them That From What I Read In Her Policy That The Insurance, Her Base Salary & 5 X Her Annual Salary Should Double Due To Her Death Resulting From An Accident. The Claims Lady Just Laughed & Said, "Sir, The Insurance Only Doubles If The Insured Person Dies Accidentally From...A Gun Shot Wound, Car Wreck, Drowning, Accident On Personal Property, Or By Choking To Death On Food, Salava, Or Vomit."
I Told Her.....Yes, That's What The Pathologist Said, She Died In Her Sleep On Vomit. As She Tried To Throw Up, She Ultimately Choked To Death On Her Own Vomit. Look On The Copy Of The Death Certificate. It Says She Died Accidentally From Aspiration Of Gastric Contents. She Then Said, Be Glad You Are Getting What You Are & Hung Up The Phone.
Look, I'm Really Having A Hard Time, w/ My Mothers Death, and I've Give A ZILLION DOLLARS To Have Her Back, But I Feel I Should Receive What Is Owed To Me. And We Are Talking About HUNDREDS Of THOUSANDS Of DOLLARS Here. I Already Have An Estate Attorney.....But Should I Pursue This...?
Do I Have A Good Shot Here?

*?--Am I Entitled To DOUBLE IMENITY INSURANCE--?*

Thanks In Advance
---MR. NW---

texansfan · Jan 29, 2008

I would pursue this as it sounds as if the insurance company is doing what most insurance companies try and do, pay as little as they can get away with. I would have your lawyer contact them and even send them whatever documentation you have to back up your claim. I am not a lawyer but it sounds like semantics to my by the insurance company. Are they saying that you have to be sitting at a dinner table and then choke to death? Something doesn't sound right to me.

HatTrick · Jan 29, 2008

Lawyer up for sure.

Timetopay · Jan 29, 2008

New you are going to have a long battle that you probably not win.

You are taking the wording to the extreme.

Hal01 · Jan 29, 2008

MR. NEWLYWED said:
She Then Said, Be Glad You Are Getting What You Are & Hung Up The Phone.
---MR. NW---

Sorry for you loss, but I'm having trouble with the above. You can dispute the findings. They have forms and procedures. If you have a valid claim the Death Benifit will be paid. Call your assigned claim specialist and review your claim in detail. If not satisfied ask about the dispute procedure. And yes speak with the Estate Attorney.

BTW, I have had my Life License for 19 years.

D2bets · Jan 29, 2008

Read the policy carefully, it's going to define accident. You should certainly explore this with your attorney, but offhand what you describe does not sound like an accidental death.

That said, the way the agent talked to you seems rather rude, insensitive and unprofessional.

PO69 · Jan 29, 2008

She is did not die of an accidental cause according to the rules. I would say that almost NO insurance company would say that this is an accident.

I assume that she was at least 57 years old or so. Is that a correct estimation of her age? Also, was she currently still working at the same job?

To be hinest, if her age is close 60, then I think that you are getting a whole lot more than most people get. I would assume by reading that this policy will pay out at around $300,000 or so, which is pretty damn good.

If you appeal the original decision, then you have to wait a long time before receiving what you are currently owed.

I know that it is alot of money, but the aggravation and time isnt worth it. You dont have a real strong case when I compare this to most accidental death policies

GameBreaker · Jan 29, 2008

My opinion is that you arent going to win this battle. Your mothers illnesses contributed to what eventually tragically happened, thus not being an accident in insurance terms.

I'm just sayin, save what you're going to go through by fighting this.

joeyfitzclick · Jan 29, 2008

You, do nothing but call a lawyer.

fhmesq44 · Jan 29, 2008

see an attorney, but not your estate attorney. At a minimum you should discuss it with someone specializing in insurance claims. Your estate/probate attorney isn't the right guy for this claim.

Joe_Hallenbeck · Jan 29, 2008

AD&D claims are very difficult, I've been told.

I know of one where the guy had a heart attack behind the wheel and died as a result of the accident. That's about as accidental as you can get. But Aetna wouldn't pay because he was obese.

TheShotDoctor · Jan 30, 2008

Time:

Timetopay said:
New you are going to have a long battle that you probably not win.

You are taking the wording to the extreme.

Wording To THE EXTREME??? That Is Straight From THE DEATH CERTIFICATE!

TheShotDoctor · Jan 30, 2008

More Info:

PO69 said:
She is did not die of an accidental cause according to the rules. I would say that almost NO insurance company would say that this is an accident.

I assume that she was at least 57 years old or so. Is that a correct estimation of her age? Also, was she currently still working at the same job?

To be hinest, if her age is close 60, then I think that you are getting a whole lot more than most people get. I would assume by reading that this policy will pay out at around $300,000 or so, which is pretty damn good.

If you appeal the original decision, then you have to wait a long time before receiving what you are currently owed.

I know that it is alot of money, but the aggravation and time isnt worth it. You dont have a real strong case when I compare this to most accidental death policies

My Mom Was Only 50....
She Was Still Working At A Fairly Large Company As An Accountant.
The Insurance Was Through Her Work.

TheShotDoctor · Jan 30, 2008

Game:

GameBreaker said:
My opinion is that you arent going to win this battle. Your mothers illnesses contributed to what eventually tragically happened, thus not being an accident in insurance terms.

I'm just sayin, save what you're going to go through by fighting this.

This Is 50% True, But The Autopsy Clearly States That Pancreatitis Did Not Contribute To Her Death.

DrunkenHorseplayer · Jan 30, 2008

Standard procedure by insurance cockroaches; your best bet is to let them know that you intend to go after them hard and that they can either pay what they owe now or that plus attorney's fees later. Don't let them frustrate you into accepting a lesser amount.

Timetopay · Jan 30, 2008

MR. NEWLYWED said:
Wording To THE EXTREME??? That Is Straight From THE DEATH CERTIFICATE!

the wording on the insurance policy goofy.

You better be ready for a fight. If the doctors say your mom was terminal and going to die shortly you lose.

Which from all the reports u gave us back then she was very very ill.

uscmd · Jan 30, 2008

Newlywed you need to start asking for referrals for an attorney who has the resources to stand up to an insurance company. Ideally a larger firm, so if it does go to trial, they'll have the income and diversity to fight the fight for as long as it takes.

It sounds like it boils down to whether weakness after serious disease and general wasting associated with losing all that weight creates a scenario where aspiration might be defined as relating to the disease as opposed to falling down stairs or accidentally shooting yourself, which are clearly accidental.

Insurance companys are just scum. They have bean counters who sit in little rooms and decide whether a particular denial and suits to follow might help the bottom line. What a life.

One last thing my friend you need to get out a pad and do some number crunching. What they are offering vs the absolute best you could get, then subtract 35% to 40% and enough stress, grief and pain is worth it. Would the differance change your life enough to be worth going through the process.

Regardless of which way you are leaning you need to do nothing before seeing a few attorneys. Don't be shy, if you find someone you think is right, get all the details out in the open.

Sorry for your loss.

TheShotDoctor · Jan 30, 2008

Thanks Alot

uscmd said:
Newlywed you need to start asking for referrals for an attorney who has the resources to stand up to an insurance company. Ideally a larger firm, so if it does go to trial, they'll have the income and diversity to fight the fight for as long as it takes.

It sounds like it boils down to whether weakness after serious disease and general wasting associated with losing all that weight creates a scenario where aspiration might be defined as relating to the disease as opposed to falling down stairs or accidentally shooting yourself, which are clearly accidental.

Insurance companys are just scum. They have bean counters who sit in little rooms and decide whether a particular denial and suits to follow might help the bottom line. What a life.

One last thing my friend you need to get out a pad and do some number crunching. What they are offering vs the absolute best you could get, then subtract 35% to 40% and enough stress, grief and pain is worth it. Would the differance change your life enough to be worth going through the process.

Regardless of which way you are leaning you need to do nothing before seeing a few attorneys. Don't be shy, if you find someone you think is right, get all the details out in the open.

Sorry for your loss.

I Really Appreciate Your Advice, aswell as others. I've Had A Divorce Attorney In The Past & I Currently Have An Estate Attorney....but Neither Will Help In This Case. I'll Be Going "Shopping" For A Good One In The Next Few Days.

TIME----Even Though My Mother Lost Her Pancreas, and Was In ICU 21 Days....Once She Made It Home & Got Her Blood Sugar Regulated, She Was Slowly Improving. And Her Family Physician & Her Surgeon Were Really Shocked, and Both Came The Visitation. Believe Me It Was Unexpected....Very Unexpected, as If I Knew This Was Going To Happen, I Would Not Have Left My Daughter There To Spend The Night On Saturday.(One Day Prior To Her Death) But Now I Think That Was A Blessing That They Spent That TIME Together.

Thanks Again Guys....I'll Be Following Up On This.

Wish Me The Best
--MR. NW--