Denied Accidental Death and Dismemberment (AD&D) Claims

If your accidental death and dismemberment (AD&D) insurance claim was denied, you are not alone. Insurance companies often deny AD&D claims by disputing whether the death or injury qualifies as an accident under the policy terms. At Lassen Law Firm, we focus exclusively on helping beneficiaries and insureds recover denied life insurance and AD&D claims nationwide. Christian Lassen, Esq., a life insurance attorney with over 20 years of experience, personally handles every case to ensure maximum recovery.

If an AD&D claim is denied, the beneficiary or insured has the right to appeal, demand the insurer’s evidence, and, if necessary, file a lawsuit for breach of contract or bad faith. Insurers must prove that exclusions or limitations apply to deny benefits.

What Is an Accidental Death and Dismemberment (AD&D) Policy?

An AD&D policy provides financial benefits if the insured suffers death or serious injury due to a qualifying accident. Covered events typically include accidental death, loss of limbs, loss of sight, or paralysis resulting directly from an accident and independently of other causes. AD&D coverage may be part of a group life insurance plan or purchased separately.

However, these policies often contain complex definitions of "accident," and insurers frequently attempt to classify accidents as excluded events.

Why AD&D Claims Get Denied

Insurance companies frequently deny AD&D claims by arguing that the death or injury was not truly accidental. They may allege that illness, intoxication, medical conditions, or voluntary risky behavior contributed to the death or injury. Insurers also sometimes cite technical exclusions buried in the policy to avoid paying benefits.

Denials are often based on narrow interpretations of what qualifies as an accident — interpretations that can and should be challenged.

How We Help With Denied AD&D Claims

At Lassen Law Firm, we challenge wrongful AD&D denials aggressively. We demand full disclosure of the insurer’s investigative file, analyze the policy terms carefully, and present evidence showing the accident qualifies for benefits. When necessary, we file lawsuits for breach of contract and insurance bad faith to enforce the policy.

For example, we recently helped a family recover a $250,000 accidental death benefit after an insurer claimed the death was caused by a "sickness" rather than an accident. Through strategic litigation, we proved the accident was the true cause and secured full payment.

Common Reasons AD&D Claims Are Denied

• Death classified as sickness, not accident

• Drug or alcohol exclusions

• Voluntary risky behavior exclusions

• Felony exclusions (death during criminal activity)

• Death caused by medical complications after an accident

• Death not "independently and exclusively" from an accident

• Pre-existing condition exclusions cited incorrectly

• Death or injury caused by self-inflicted harm

• Employer-sponsored policy disputes under ERISA

• Failure to meet proof of loss deadlines

What to Do After a Denied AD&D Claim

If your AD&D claim has been denied, follow these steps:

1. Request a detailed denial letter explaining the insurer’s reasons.

2. Gather all medical records, death certificates, accident reports, and policy documents.

3. Do not attempt to appeal directly without legal advice.

4. Contact a life insurance and AD&D attorney experienced with denied claims.

5. Move quickly — appeal and lawsuit deadlines can be short.

Getting an attorney involved early can make the difference between a successful recovery and a lost claim.

Frequently Asked Questions About Denied AD&D Claims

What qualifies as an accident under an AD&D policy?

An accident typically means an unexpected, external event that causes death or serious injury, without contribution from sickness or intentional acts.

Can AD&D claims be denied if alcohol was involved?

Yes. Many AD&D policies exclude coverage if the insured was intoxicated at the time of the accident, even if alcohol did not directly cause death.

What is an illness exclusion in AD&D policies?

An illness exclusion denies coverage if death or injury resulted directly or indirectly from a sickness rather than an accident. Insurers often misuse this to avoid paying.

Can a death caused by medical treatment after an accident be excluded?

Insurers sometimes argue that medical complications negate accident coverage. However, courts often side with beneficiaries if the initial cause was truly accidental.

What happens if death occurred during a felony?

Most AD&D policies exclude coverage if the insured died while committing a felony. Proof of the felony is required for denial to stand.

Are deaths during risky hobbies excluded?

Possibly. Activities like skydiving, racing, or mountaineering may trigger exclusions if specifically listed in the policy.

How do insurers investigate AD&D claims?

Insurers review medical records, police reports, toxicology results, and witness statements to try to disprove accident claims.

Can I appeal a denied AD&D claim?

Yes. You can appeal and demand the insurer's entire claims file. Appealing with an attorney's help greatly increases your chances of success.

How long does it take to resolve a denied AD&D claim?

Most cases resolve within a few months if aggressively pursued, although complex cases involving disputes over accident classification may take longer.

Do group AD&D policies through work have special rules?

Yes. If the policy is governed by ERISA, you must exhaust the plan’s appeal process before filing a lawsuit.

What is proof of loss in AD&D claims?

Proof of loss typically includes medical documentation, accident reports, and death certificates showing the cause of injury or death.

Can insurers delay AD&D claims for long periods?

They can try, but unreasonable delays may constitute bad faith. Insurers are required to act promptly in investigating and paying valid claims.

What should I do if the insurer claims the death was “natural causes”?

Demand full disclosure of their investigative file and consult an attorney to challenge their findings and argue for accident classification.

Are heart attacks or strokes covered under AD&D policies?

Usually not — unless a heart attack or stroke was caused by a traumatic accident. Each case depends heavily on specific facts.

Can partial injuries like loss of a finger or vision be covered?

Yes. AD&D policies often pay partial benefits for loss of limbs, sight, hearing, or paralysis, depending on the severity and policy language.

Does suicide void an AD&D claim?

Yes. Most policies exclude coverage for self-inflicted injuries or suicide, whether intentional or while mentally impaired.

Can prescription drug overdoses be considered accidents?

Rarely. Most policies exclude overdoses, but if the overdose was unintentional and accidental, it may still qualify depending on policy language.

Do toxicology reports affect AD&D claims?

Yes. Insurers use toxicology reports to argue intoxication exclusions. Interpretation of these reports is often key to winning disputes.

How can I fight a denied AD&D claim?

Work with an experienced life insurance attorney to demand the insurer’s evidence, challenge wrongful denials, and litigate if necessary.