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 Accidental Death and Dismemberment Coverage
Accidental death and dismemberment insurance provides benefits when death or serious injury results directly from an accident and independently of other causes. Covered losses may include accidental death, loss of limbs, loss of sight or hearing, and paralysis caused by an accident.
AD&D coverage is often included in group life insurance plans or purchased as a separate policy. These policies contain detailed definitions of what qualifies as an accident, which insurers frequently rely on to deny claims.
Why AD&D Claims Are Denied
AD&D claims are commonly denied because insurers dispute whether the loss was truly accidental. Denials often focus on causation or policy exclusions rather than the accident itself.
Common denial reasons include:
• Classification of death as illness rather than accident
• Drug or alcohol exclusions
• Voluntary risky behavior exclusions
• Criminal activity exclusions
• Medical complications following an accident
• Contributing health conditions
• Pre existing condition language
• Employer sponsored policy administration errors
Immediate Steps After a Denial
Request a written denial letter from the insurer
Collect the policy, medical records, and accident documentation
Keep copies of all correspondence
Avoid appealing without understanding policy requirements
Be aware of strict deadlines, especially under ERISA
Basic Legal Principles
• Insurers must prove exclusions apply
• Policy language is interpreted under contract law
• ERISA governs many employer sponsored AD&D plans
• Improper denials can be challenged
Frequently Asked Questions
What qualifies as an accident
An event that causes death or injury directly and independently of other causes.
Can alcohol automatically bar coverage
Not always. Exclusions must be proven and properly applied.
How long are appeal deadlines
Some ERISA deadlines may be as short as 60 to 90 days.
Do beneficiaries have the right to challenge denials
Yes. Many AD&D denials are overturned when challenged.
Key Takeaways
• AD&D claims are denied more often than standard life insurance claims
• Insurers frequently misuse exclusions and definitions
• Beneficiaries have enforceable legal rights
• Prompt action improves outcomes
For legal representation and detailed analysis of denied AD&D claims, see our main page on Denied Accidental Death and Dismemberment Claims or contact our office for a free consultation.
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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
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.
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The Right Choice for Your Claim
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“They tried to connect my father’s death to an undisclosed pre-existing condition. Christian's firm reviewed the full medical file and showed it had no bearing. Within a month, we had the check.”- Susan B.
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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