We were recently retained to seek accidental death and dismemberment benefits from The Prudential Insurance Company of America (“Prudential”). The insured was involved in a motorcycle accident suffering severe injuries. The policy requires that a death occur within 365 days of the accident in order to claim life insurance benefits. Although the insured died as a result of the accident, his death occurred more than 365 days after the accident. However, the policy also provides for the payment of benefits if the insured suffered other losses – including the loss of speech, vision, hearing or the loss of use of one or more limbs during the 365 day window. In this case, the claimant suffered the loss of speech and paraplegia –- losing his ability to walk — within 365 days of the accident. In spite of these covered losses Prudential refused to pay any benefits under the insurance policy.
As with many policies, the Prudential policy requires that we file an administrative appeal prior to filing a lawsuit. An appeal has been filed seeking these benefits.