Translating Accidental Death & Dismemberment insurance coverage into plain English.
By Liz Sherman, F130225
When I complained to my husband, FMCA Insurance and Risk Management Committee chairman Dick Sherman, about how difficult it is to understand the association’s Accidental Death & Dismemberment (AD&D) policy, he pointed out two things: 1) It is not a policy that I see in the magazine but simply a description of the policy; and 2) It seems perfectly clear and straightforward to him.
I should mention that Dick is an insurance person who has mastered the convoluted and specialized language of “insurance-speak.” I had to disagree. To me, that page in the magazine reads and looks like a close relative of the federal tax instruction booklet — a tangle of words and numbers thrown on a page.
The insurance person at my house — Dick — challenged me to make the AD&D coverage more comprehensible to the average FMCA member . . . if I could! Which brings me to the purpose of this article: I will try to untangle the language involved in the AD&D coverage and make it more understandable to those who do not speak insurance-speak.
I hope I succeed in simplifying the information, because this coverage could be very important to any of us. It’s one of those coverages that I hope I won’t need, but I’ll be grateful that I have it if I do. I think you’ll agree.
By the way, AD&D is not to be confused with the Deductible Reimbursement Insurance Plan, which provides group travel accident, medical deductible, and co-insurance reimbursement coverage. (An article discussing that plan begins on page 208.)
AD&D is a free benefit that comes with your FMCA membership. The most important thing to know about this benefit is that as long as you are a life or a family member of FMCA, you own an Accidental Death and Dismemberment Insurance Policy. If you or your spouse suffers grievous injury from an accident, you may be entitled to monetary benefits. If you lose a limb, lose your sight, or lose your hearing in an accident, you may qualify for dismemberment coverage. AD&D coverage is worldwide, 24 hours a day, 365 days a year.
The most important thing you should do regarding the AD&D policy description is to find it in the magazine, keep it, and let your family know about it. Send a copy to your attorney, if you wish. It is an Accidental Death and Dismemberment Policy.
Take a look at the AD&D certificate on page 207 of this issue of the January 2003 issue of Family Motor Coaching magazine. Cut out the certificate and refer to it as you read this article. Then sign it and store it with your other important papers.
Now let’s actually look at the policy description as it appears in FMC magazine. If you are a family or a life member of FMCA, the extent of your coverage is spelled out on the certificate. When I first looked at this policy description in the magazine awhile ago, my first instinct was to slam the magazine shut. However, it’s worth our while to concentrate on it for a few minutes and try to figure it out.
Near the top left of the page you’ll notice the word “Schedule” in bold type. This refers to a list of categories — where you are and what you are doing, in a general sense, when you suffer dismemberment or death as a result of an accident. The money amounts to which you are entitled are also shown. Beneath “Schedule,” you will see “Coverage A,” “Coverage B,” and “Coverage C.” This is not a multiple-choice test.
Coverage “A” provides a benefit when there is a death of a member or covered child resulting from an accident when you are not traveling in your motorhome or providing emergency repairs on or around it. (I will explain what a “covered child” is later in this article.) This section shows you the dollar benefits for the estate of the person who died as a result of the accident.
For the dollar benefits for “dismemberment,” you have to look toward the bottom of the right-hand column, under the heading “Accidental Death And Dismemberment.” Dismemberment may sound like a description of Dr. Frankenstein’s activities, but we do need to learn more about this distasteful-sounding insurance term.
Dismemberment refers to the loss of certain body “members.” The AD&D policy states how much money you would be entitled to if you lost your sight and/or a limb as a result of an accident. You do not have to be traveling in or near your motorhome to be eligible for dismemberment coverage; you are covered anytime, anywhere. However, if you have an accident while traveling in your motorhome or making emergency repairs to the coach, your benefits are much higher. How much higher?
The answer lies in the “Accidental Death And Dismemberment” section. You’ll see that the first entry is “For Loss of Life …. The Principal Sum.” The Principal Sum refers to the dollar amounts listed in each of the coverages, “A” through “C.” So, once you have figured out which of the listed coverages applies to your accident, you can look back and forth between the coverage schedule on the left side of the policy description and the AD&D schedule on the right side of the page.
For example, suppose I was thrown off an escalator at my local mall and consequently lost a foot. (See Coverage “A.”) Referring to the “For Loss of” information under “Accidental Death And Dismemberment,” you’ll see that I would be entitled to one-half of The Principal Sum ($2,000 divided by 2), which is $1,000.
Coverage “B” refers to accidental death or dismemberment while in a common carrier. “Common carrier” is another insurance term. When you pay for transportation, you are in a common carrier. You must be a paying passenger to qualify for this coverage. Examples of common carriers are buses, taxis, planes, trains, limousines, and tourist horse and buggies.
In this case, your benefits really go up! To continue my personal example, suppose I am traveling in a commercial tourist van to the top of Mount Washington in New Hampshire. The van crashes and I am hurled out of the van and over the side of the mountain, losing a foot in the fall. The loss of my foot would result in benefits of one-half of The Principal Sum. According to Coverage “B,” which indicates a principal sum of $10,000, I would be entitled to $5,000 ($10,000 divided by 2). If I were to die in the van accident, my beneficiaries would receive $10,000, the entire principal sum.
Under Coverage “B,” invited guests are also included if the accident occurs at least 50 miles from their primary residence. Let’s continue my example. Let’s say that my sister, a Montana resident and my guest on the trip, was hurled out of the van with me and lost a hand. She also would be entitled to one-half of The Principal Sum, or $5,000.
Coverage “C” lists dollar benefits for members who are killed or dismembered as a result of a motorhome accident while they are traveling in their motorhome or making emergency repairs to the motorhome. This coverage covers your invited guests as well.
An FMCA member or spouse is covered for $10,000 in case of death or dismemberment while they are traveling in their motorhome or making emergency repairs to it. For example, suppose that while driving up Mount Washington, Dick hits a rut and I am tossed out the window and down the side of the mountain. If I die from injuries sustained in the accident, Dick would receive $10,000 through the AD&D policy. Coverage “C” also includes coverages for “covered” children. In addition, invited guests are covered if the accident occurs at least 50 miles from their primary residence.
Referring to the certificate again, below “Coverage C” you’ll see the heading “Definition.” This section is meant to help you understand the insurance jargon that is included on the certificate and in your policy. It may or may not help. Come back to this part later — I did.
Now go to the top of the next column to the section called Dependent Coverage. Here is information that you will surely want to know in case of an accident. For instance, who are “covered children”? This part of the certificate is quite specific about that. Covered children are primarily dependent children younger than 19 who are unmarried. Read the section for specifics.
Exclusions. This is another insurance word. It means who and what are not covered. These are the conditions cited by cynics when they are insurance-bashing. Even our cynics would agree, however, that these are common-sense conditions. For example, you will not be covered by AD&D if:
- You commit suicide.
- You injure yourself in a failed suicide attempt.
- You are involved in a war or act of war.
- You sustain an injury while serving as a member of the armed forces.
- You have an accident in a plane that is not a civic, a public, or a military transport aircraft.
- You are taking drugs (unless they have been prescribed by a physician) when you have an accident.
- You are legally intoxicated while operating a motor vehicle.
At this point, you might be wondering, “How do I or my heirs get these benefits?” Good question, and the answer is simple. Make sure your spouse knows about the policy. Also, you should file the certificate with your personal estate papers, along with your other life insurance policies.
Within 365 days of an accident, your executor would call FMCA insurance specialist Jim Flint at (800) 241-8363 and explain what happened. If the claim is for dismemberment, you or your representative would call Mr. Flint at the same number. Mr. Flint would then submit the claim for you. Just be sure you have made the existence of this policy known, not just to your spouse but to others who might be involved in settling your affairs.
You may have more questions about the AD&D. This policy is explained during insurance seminars at FMCA area rallies and national conventions. These are terrific opportunities to have your questions answered personally. You can also call Mr. Flint, who often conducts the aforementioned seminars. He sent me the following list of frequently asked AD&D questions and the corresponding answers.
Q: Is this a new policy?
A: No. The AD&D policy has been in existence since 1983.
Q: What type of claims have you received?
A: The largest number of claims by category has been automobile accidents as a driver or passenger. Next comes pedestrians struck by a motor vehicle. Third are falls that result in death, most from the top of a motorhome.
Q: Who is covered by AD&D and under what conditions are they covered?
A: As mentioned earlier in this article, all of us who are family or life members of FMCA are covered. Coverage is 24 hours a day, 365 days a year, and is worldwide, with no territorial restrictions.
Q: How do I name a beneficiary?
A: We have already done that for you. The AD&D policy states the following order of claim payment: surviving spouse; lawful children sharing equally; and, if you are not survived by a spouse or children, your estate. However, you can name any beneficiary you wish, such as a trust or charity, simply by submitting your request to FMCA in writing.
That’s all there is to it. You now know that you have coverage for death or dismemberment due to an accident. That’s really all you need to remember.
I hope I have helped you learn more about this terrific FMCA member benefit. Now it’s time for you to sign the AD&D certificate. Right now!
Exclusions And Limitations
The policy will not pay for losses resulting from: suicide or self-inflicted injury; declared or undeclared war or any act of war; full-time active duty in the armed forces of any country or international authority; any accident as a result of alcohol or non-prescription narcotics; infections other than pus-forming infections sustained through an accidental cut or wound; flying in any company-owned, operated, or leased private aircraft; or racing endurance tests; or any operation of an experimental aircraft that requires a special permit or waiver from the authority having jurisdiction over civil aviation, even though granted.
The above description summarizes the principal features of the Member Accident Protection Plan and is not intended to be a contract. The contractual provisions are stated in the Master Policy (ADD-1103) issued by The Hartford to The Family Motor Coach Association Inc., with an effective date of January 1, 2002. The final answer to any questions will be subject to the Master Policy. All insureds will receive a Certificate of Insurance as proof of coverage. Your Certificate of Insurance is printed on page 207 of this issue.
There is no longer an offer in effect for 90 days free additional AD&D coverage. Additional coverage is available for purchase.