Accidental Death and Dismemberment riders, commonly called AD&D riders, promise enhanced benefits when death results from an accident. But when a fatal accident involves any medical finding, insurers often seize on it to argue the death was not truly accidental. The most common tactic is blaming a heart attack or other medical event instead of the accident itself.
This case shows how that strategy works and how it can be defeated.
What an AD&D Rider Is Supposed to Cover
An AD&D rider is an add-on to a standard life insurance policy. It pays additional benefits when death is caused by a qualifying accident. These riders often double or triple the payout.
For example, a $500,000 base policy with a $1.5 million AD&D rider could pay a total of $2 million if the insured dies accidentally.
What insurers do not emphasize is how narrowly they later interpret the word accidental.
If an insurer can argue that death was caused by illness instead of trauma, they will deny the AD&D benefit while still paying the base life insurance amount.
A Careful Pilot and a Violent Crash
Steve was a 48-year-old accountant, husband, and father of three. He was also a licensed private pilot who flew recreationally on weekends. He was known for careful planning, strict adherence to safety procedures, and conservative decision-making.
One Saturday morning, Steve attempted to land his single-engine aircraft as severe weather moved into the area. Crosswinds were strong and unpredictable. During final approach, a gust lifted one wing sharply. The opposite wing struck the runway, causing the aircraft to roll and burst into flames.
Steve was killed at the scene.
The Partial Payment and the AD&D Denial
Steve’s policy included a $500,000 life insurance benefit and a $1.5 million AD&D rider. His wife Stacey filed a claim and submitted all required documentation, including FAA and emergency response reports.
The insurer paid the base life insurance benefit without issue.
But it denied the AD&D claim.
The reason was a single line in the autopsy report suggesting Steve may have suffered a heart attack shortly before or during the crash. The insurer argued that the heart attack caused Steve’s death, not the impact, and therefore the death was not accidental under the rider.
Why the Insurer’s Argument Failed
Stacey’s brother Mark was a lawyer with experience handling denied life insurance claims. He recognized the insurer’s position as a classic AD&D denial tactic.
The policy did not exclude coverage simply because a medical condition existed. To deny benefits, the insurer had to prove that the medical event was the primary cause of death and that the accident did not materially contribute.
That proof did not exist.
Mark assembled evidence showing:
• Severe crosswinds documented by weather data
• Steve was conscious and communicating shortly before the crash
• The aircraft suffered catastrophic structural damage on impact
• The autopsy could not determine whether the heart event occurred before, during, or after impact
Most importantly, there was no medical evidence that Steve would have died absent the crash.
In AD&D cases, if an accident substantially contributes to death, coverage typically applies even when a medical condition is present.
The Court’s Ruling
The court ruled that Steve’s death resulted from a qualifying accident.
The judge found that the insurer failed to prove that the alleged heart attack independently caused death or that the crash was merely incidental. The physical trauma and fire were sufficient on their own to cause death.
The insurer was ordered to pay the full $1.5 million AD&D benefit, plus interest.
Why Insurers Target AD&D Claims
AD&D riders expose insurers to large payouts. When an accident involves any medical finding, insurers often attempt to reframe the death as natural rather than accidental.
Common denial tactics include claiming:
• A heart attack caused the death
• A stroke or seizure occurred first
• An underlying condition triggered the accident
• The accident was not the true cause
These arguments often rely on speculation rather than proof.
What to Do If an AD&D Claim Is Denied
If an AD&D claim is denied based on a medical condition:
• Request the denial in writing
• Obtain the full policy and rider language
• Review whether the policy requires sole causation or substantial contribution
• Gather accident reports and expert opinions
• Speak with a lawyer experienced in AD&D denials
Many of these denials can be reversed when causation is properly analyzed.
We Challenge AD&D Denials Nationwide
AD&D denials based on alleged medical events are among the most aggressively contested claims in life insurance. Insurers rely on confusion about causation and policy language.
Our firm focuses exclusively on denied life insurance and AD&D claims. We know how insurers misuse medical findings to avoid paying benefits, and we know how to dismantle those arguments. There is no fee unless benefits are recovered.