Denied AD&D Claim Fact Sheet
Christian Lassen, Esq. | Quoted in The Wall Street Journal | 25 Years Experience Helping beneficiaries and insureds nationwide recover denied AD&D claims.
What Is AD&D Coverage?
Accidental Death and Dismemberment (AD&D) insurance provides financial benefits when death or serious injury results directly from an accident and independently of other causes. Covered events may include:
- Accidental death
- Loss of limbs
- Loss of sight or hearing
- Paralysis caused by an accident
AD&D coverage may be purchased separately or included in group life insurance plans. Policies often contain complex definitions of “accident,” which insurers use to dispute claims.
Why AD&D Claims Get Denied
Insurance companies frequently deny AD&D claims by narrowing the definition of “accident” or citing exclusions. Common denial reasons include:
- Death classified as illness, not accident
- Drug or alcohol exclusions
- Voluntary risky behavior exclusions (skydiving, racing, etc.)
- Felony exclusions (death during criminal activity)
- Medical complications following an accident
- Death not “independently and exclusively” from an accident
- Pre‑existing condition exclusions misapplied
- Self‑inflicted injury allegations
- Employer errors in ERISA‑governed policies
- Missed proof of loss deadlines
What To Do After a Denied AD&D Claim
- Request a detailed denial letter explaining the insurer’s reasoning.
- Gather documentation medical records, accident reports, death certificates, and policy documents.
- Avoid appealing alone insurer appeal processes often favor the company.
- Consult an experienced AD&D attorney to challenge the denial.
- Act quickly ERISA and state deadlines can be short, and missing them may end your claim.
Your Legal Rights
- Insurers must prove exclusions or limitations apply.
- Beneficiaries can appeal, demand evidence, or file suit for breach of contract or bad faith.
- Courts often side with beneficiaries when insurers misclassify accidents or misuse exclusions.
Case Example
Our firm helped a family recover a $250,000 accidental death benefit after an insurer claimed the death was caused by “sickness” rather than an accident. Through litigation, we proved the accident was the true cause and secured full payment.
Frequently Asked Questions
Q: What qualifies as an accident under AD&D policies?
A: Events that cause death or injury directly and independently of other causes, such as car crashes or falls.
Q: Can insurers deny claims due to alcohol or drug use?
A: Yes, many policies contain exclusions. Attorneys can challenge whether the exclusion truly applies.
Q: How long do I have to appeal?
A: Deadlines vary, but ERISA appeals can be as short as 60–90 days.
Q: Do I need an attorney?
A: Yes AD&D denials are complex, and experienced counsel increases the chance of overturning them.
How We Help
- Demand full disclosure of insurer investigative files.
- Challenge wrongful exclusions and narrow definitions of “accident.”
- File lawsuits for breach of contract and bad faith.
- Represent clients nationwide in appeals and litigation.
- Secure rightful payouts for families across all 50 states.
Contact Us
If your AD&D claim has been denied, don’t wait. Deadlines are short, and insurers count on families giving up. Call 800‑330‑2274 for a free consultation. No fees unless we win.
Key Takeaways
- AD&D claims are often denied by misclassifying accidents or citing exclusions.
- Beneficiaries have strong legal rights to challenge denials.
- Quick action is critical, deadlines are short.
- Experienced attorneys dramatically improve the chances of success.
Free Case Evaluation Contact Us!
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: Dec 3, 2025 | Contact 800-330-2274
Our FAQ
Have questions? We are here to help. Still have questions or can't find the answer you need? Give us a call at 800-330-2274 today!
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A grace period is the time after a missed payment during which the policy remains in force, usually 30 to 60 days depending on state law and policy terms.
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No. In most states, insurers must send a written notice of overdue premiums and warn of pending lapse before terminating coverage.
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The policy may still be enforceable. Beneficiaries can challenge the lapse based on the insurer’s failure to provide required notice.
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Yes. If the insured dies during the grace period, the policy is still considered active, and benefits should be paid.
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Yes. In group life insurance policies, employers sometimes fail to forward premiums properly, leading to wrongful lapse denials.
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Yes. If automatic payment setups fail through no fault of the insured, lapses may be challenged.
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Some policies automatically borrow against cash value to cover missed payments. Failure to apply this correctly can lead to wrongful lapse claims.
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Possibly. Some courts excuse nonpayment if the insured was mentally incapacitated and missed premiums without proper notice.
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No. Reinstatement must occur while the insured is alive, but wrongful lapse denials can still be challenged posthumously.
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Not without following strict notice and grace period rules. Beneficiaries can often challenge technical denials.
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Deadlines vary by state, but it’s critical to act within 1 to 5 years depending on the policy and jurisdiction.
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Not necessarily. Payments mailed within grace periods or accepted by insurers may keep coverage active.
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Bank records, payment receipts, insurer correspondence, and premium notices are key evidence.
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If the insurer used an outdated address despite updated information, lapse denials can often be overturned.
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Possibly. If the insured submitted a reinstatement application before death, it may help challenge a lapse denial.
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In some states, special grace periods and protections applied during COVID-19 emergencies. They can help fight wrongful lapses.
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Only if the insurer followed all legal notice and grace period requirements. Otherwise, beneficiaries may still recover.
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Misapplied premiums can lead to wrongful lapses — and courts often hold insurers accountable for these errors.
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An attorney can obtain records, challenge improper lapses, negotiate settlements, and litigate if necessary to enforce payment.
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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Recognized ExpertisePerfect 10.0 Avvo rating endorsed by over 1,700 attorneys; life member of the Multi-Million Dollar Advocates Forum; ranked among the top 1 percent of lawyers nationally for life insurance litigation.
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Client-First AdvocacyNo upfront fees: our contingency fee guarantee aligns our interests with yours; we provide personalized, compassionate representation from your initial consultation through resolution.
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Media & Community LeadershipQuoted in The Wall Street Journal and featured in leading legal publications; frequent speaker at national conferences; dedicated to charitable efforts supporting pediatric cancer care.
