Why Was My AD&D Claim Denied?
Accidental Death and Dismemberment claims are most often denied because the insurance company asserts that the death or injury does not meet the policy’s definition of an accident. Unlike standard life insurance, AD&D policies rely heavily on causation analysis and exclusions, which insurers frequently use to justify denial.
A denied AD&D claim does not automatically mean benefits are unavailable. Many denials are based on disputed interpretations of medical evidence or policy language and can be challenged.
How AD&D Policies Define an Accident
Most AD&D policies require that the death or injury result directly and independently from an accident. Insurers typically examine whether:
• The event was sudden and unexpected
• A medical condition contributed to the outcome
• The loss resulted from trauma rather than illness
Even when an accident clearly occurred, insurers may argue that something else caused the death or injury.
Medical Cause Versus Accidental Cause Disputes
One of the most common AD&D denial arguments is that a medical condition caused the loss rather than the accident itself.
Insurers may claim that:
• A heart condition caused a fall
• A seizure, stroke, or diabetic episode triggered the event
• A pre existing condition contributed to the outcome
Policies vary, but insurers generally must prove that the medical condition, not the accident, was the primary cause under the policy terms.
Alcohol and Drug Related Denials
AD&D claims are frequently denied based on alleged intoxication. Insurers may rely on toxicology results to argue that:
• Alcohol or drugs caused the accident
• Substance use automatically bars coverage
• Prescription medication triggered an exclusion
Intoxication exclusions are not always enforceable. The insurer must show a direct connection between substance use and the death or injury.
Risky Activity and Exclusion Based Denials
Many AD&D policies exclude coverage for certain activities. Common examples include:
• Aviation incidents
• Motorized racing or extreme sports
• Certain occupational hazards
• Criminal or intentional acts
Insurers sometimes apply exclusions too broadly or without proving that the excluded activity actually caused the loss.
Self Harm Allegations
Some AD&D denials are based on allegations of intentional self inflicted injury. These denials are highly fact sensitive.
Insurance companies generally carry a heavy burden to prove intent. When circumstances are unclear, policy language is often interpreted in favor of coverage.
Does a Denial Mean the AD&D Claim Is Over?
No. AD&D denials are frequently reversed through appeals or legal action. Many initial denials rely on incomplete investigations or unsupported assumptions about causation.
A denial letter is often the starting point, not the end of the claim.
What to Do After an AD&D Claim Is Denied
If your AD&D claim has been denied:
• Obtain the denial letter and full policy
• Identify the exact exclusion or definition relied upon
• Review how the insurer classified the cause of death or injury
• Preserve medical, autopsy, and accident records
• Avoid appealing or responding without understanding the policy language
Early, informed action can significantly affect the outcome.
Related Guidance
For more information about challenging accidental death denials, see our Denied AD&D Claim page, and our Denied AD&D Claim Fact Sheet.
If an insurance company has denied an AD&D claim, it may still be possible to recover the full accidental death or dismemberment benefit.
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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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“We were told the policy lapsed before my mother died. But we had receipts showing otherwise. Lassen Law Firm used them to force the company to honor the contract. They don’t mess around.”- David K.
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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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