Denied Accidental Death and Dismemberment (AD&D) Claims
Christian Lassen, Esq. | Quoted in The Wall Street Journal | 25 Years Experience
If your accidental death and dismemberment insurance claim was denied, you are not alone. AD&D claims are denied at a far higher rate than standard life insurance claims, often because insurers aggressively dispute whether the death or injury qualifies as an accident under the policy. These denials frequently occur even when the underlying event was sudden, unexpected, and traumatic.
At Lassen Law Firm, we focus exclusively on helping beneficiaries and insureds recover denied life insurance and AD&D claims nationwide. Christian Lassen, Esq., has 25 years of experience challenging insurance company denials and personally handles every AD&D case to ensure insurers are held accountable.
Understanding AD&D Insurance Coverage
Accidental death and dismemberment policies provide benefits when death or serious injury results directly from an accident and independently of other causes. Covered losses commonly include accidental death, loss of limbs, loss of sight or hearing, and paralysis caused by an accident.
AD&D coverage may be purchased as a standalone policy or included as part of an employer sponsored life insurance plan. These policies often contain highly technical definitions of what qualifies as an accident, and insurers frequently rely on those definitions to deny claims.
The key issue in most AD&D cases is causation. Insurers often argue that a sickness, medical condition, or excluded behavior contributed to the death or injury. Beneficiaries are left fighting over whether the accident was the true and predominant cause of loss.
Why AD&D Claims Are Frequently Denied
Insurance companies routinely deny AD&D claims by narrowly interpreting policy language. Common tactics include reclassifying accidental deaths as medical events, emphasizing contributing health conditions, or invoking exclusions that do not truly apply.
Insurers may claim that alcohol or drug use contributed to the accident, that the insured engaged in voluntary risky behavior, or that a pre existing condition played a role. In fatal cases, insurers often argue that death was caused by illness rather than trauma, even when the accident clearly triggered the fatal outcome.
These interpretations are often flawed and legally challengeable.
How We Challenge Denied AD&D Claims
At Lassen Law Firm, we approach denied AD&D claims with a detailed causation analysis. We obtain the insurer’s full investigative file, review medical and autopsy records, analyze accident reports, and carefully interpret the policy language.
Our goal is to demonstrate that the accident was the direct and independent cause of death or injury under the policy. When insurers refuse to reverse course, we pursue litigation for breach of contract and insurance bad faith.
In one recent case, we helped a family recover a $250,000 accidental death benefit after the insurer claimed the death resulted from sickness rather than an accident. Through litigation, we established that the accident was the primary cause and secured full payment.
Common Reasons AD&D Claims Are Denied
• Death classified as sickness rather than accident
• Drug or alcohol exclusions
• Voluntary risky behavior exclusions
• Felony or criminal activity exclusions
• Medical complications following an accident
• Failure to prove death occurred independently of other causes
• Misapplication of pre existing condition exclusions
• Allegations of self inflicted harm
• ERISA disputes involving employer sponsored policies
• Missed or disputed proof of loss deadlines
What To Do After an AD&D Claim Is Denied
If your AD&D claim has been denied, take these steps promptly:
- Request a detailed written denial letter
- Gather medical records, autopsy reports, accident documentation, and the policy
- Do not submit an appeal without legal guidance
- Contact an attorney experienced in AD&D claim litigation
- Act quickly, as ERISA and state deadlines can be strict
AD&D claims are among the most technical and aggressively contested insurance claims. Early legal involvement can be decisive.
For a concise overview of AD&D denials and immediate steps, see our Denied AD&D Claim Fact Sheet.
See our Denied AD&D Claim Fact Sheet
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Written & Reviewed by Christian Lassen, Esq., Nationally recognized life insurance lawyer: 25 years experience, hundreds of millions recovered. Quoted in The Wall Street Journal ( May 17, 2025).
Last reviewed: Jan 3, 2026 | Contact 800-330-2274
Frequently Asked Questions About Denied AD&D Claims
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An accident typically means an unexpected, external event that causes death or serious injury, without contribution from sickness or intentional acts.
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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.
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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.
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Insurers sometimes argue that medical complications negate accident coverage. However, courts often side with beneficiaries if the initial cause was truly accidental.
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Most AD&D policies exclude coverage if the insured died while committing a felony. Proof of the felony is required for denial to stand.
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Possibly. Activities like skydiving, racing, or mountaineering may trigger exclusions if specifically listed in the policy.
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Insurers review medical records, police reports, toxicology results, and witness statements to try to disprove accident claims.
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Yes. You can appeal and demand the insurer's entire claims file. Appealing with an attorney's help greatly increases your chances of success.
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Yes. You can appeal and demand the insurer's entire claims file. Appealing with an attorney's help greatly increases your chances of success.
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Most cases resolve within a few months if aggressively pursued, although complex cases involving disputes over accident classification may take longer.
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Yes. If the policy is governed by ERISA, you must exhaust the plan’s appeal process before filing a lawsuit.
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Proof of loss typically includes medical documentation, accident reports, and death certificates showing the cause of injury or death.
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They can try, but unreasonable delays may constitute bad faith. Insurers are required to act promptly in investigating and paying valid claims.
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Demand full disclosure of their investigative file and consult an attorney to challenge their findings and argue for accident classification.
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Usually not — unless a heart attack or stroke was caused by a traumatic accident. Each case depends heavily on specific facts.
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Usually not — unless a heart attack or stroke was caused by a traumatic accident. Each case depends heavily on specific facts.
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Yes. AD&D policies often pay partial benefits for loss of limbs, sight, hearing, or paralysis, depending on the severity and policy language.
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Yes. Most policies exclude coverage for self-inflicted injuries or suicide, whether intentional or while mentally impaired.
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Rarely. Most policies exclude overdoses, but if the overdose was unintentional and accidental, it may still qualify depending on policy language.
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Yes. Insurers use toxicology reports to argue intoxication exclusions. Interpretation of these reports is often key to winning disputes.
Our Clients Speak Volumes
The Right Choice for Your Claim
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“They alleged policy fraud and said they wouldn’t pay. But Christian Lassen’s firm uncovered emails showing the insurer had approved everything months earlier. They settled the case quietly and quickly once the truth came out.”- Linda T.
Why The Lassen Law Firm Is Different
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Proven National Results
With over two decades of exclusive focus on life insurance litigation, we’ve helped thousands of families recover wrongfully denied benefits. Our reputation for fast, strategic resolutions has made us a trusted national resource for complex claim disputes.
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