Can an Insurance Company Deny Accidental Death Benefits Due to a Pre-Existing Medical Condition?
Yes—and they try to do it more often than most people realize. Life insurance companies are notorious for using Accidental Death & Dismemberment Riders (AD&D) as a trap: they entice buyers with the promise of higher payouts, then deny the benefit when tragedy strikes by claiming the death wasn’t truly accidental.
In this post, we explore a real-life case where a widow’s claim for an AD&D payout was denied because the insurance company focused on a possible heart attack—not the plane crash that actually caused her husband’s death. Fortunately, with the help of a skilled attorney, justice prevailed.
What Is an AD&D Rider in a Life Insurance Policy?
An Accidental Death and Dismemberment Rider (AD&D) is a policy add-on that pays out additional benefits—often double or triple the base amount—if the insured dies as the result of a qualifying accident.
For example, if a person has a $500,000 life insurance policy and a $1.5 million AD&D Rider, their beneficiary could receive a total of $2 million if the insured dies accidentally. These riders are especially popular among young families and breadwinners who want to maximize their family’s protection in the event of a sudden, unexpected tragedy.
But there's a catch: the definition of “accidental” is left largely to the insurer’s interpretation—and they often use that gray area to deny payouts.
The Pilot, the Policy, and the Crash
Steve was a 48-year-old accountant, husband, and father of three. In addition to excelling at his job, he was a licensed amateur pilot who flew every Saturday morning. He loved the solitude and challenge of piloting a small aircraft—and he was meticulous about safety.
That dedication made it all the more devastating when Steve died in a crash after attempting to land during a storm with strong crosswinds. Although the final approach was tense, Steve had spoken with his wife moments before impact and expressed confidence in his instrumentation.
But nature had other plans. As he began his descent, a fierce crosswind pushed one wing sharply upward. The other struck the tarmac, causing the plane to roll and erupt into flames. Steve died at the scene.
The Denial That Followed
Steve’s life insurance policy included a $500,000 death benefit and a $1.5 million AD&D Rider. His wife, Stacey, filed a timely claim after the accident, submitting the required documents: the death certificate, autopsy report, and official investigation reports from the FAA and emergency responders.
The insurance company had no issue paying the base benefit. But when it came to the AD&D Rider, the adjuster dug into the autopsy report, which mentioned that Steve had suffered a heart attack prior to or during the crash.
The insurer seized on this fact, claiming that the heart attack—not the crash—was the true cause of death, and denied the additional $1.5 million payout under the AD&D rider.
Heart Attack vs. Impact: A Legal Battle Over Cause of Death
Fortunately, Stacey’s brother Mark was an attorney who specialized in life insurance claim denials. He knew the insurer’s argument was weak. Just because Steve had a heart attack didn’t mean it caused his death—and certainly didn’t erase the reality of a fiery plane crash.
Mark gathered expert testimony, meteorological data, and reports from the National Transportation Safety Board. He pointed out:
The weather: Strong, documented crosswinds contributed to the crash.
The timing: Steve was alive and coherent just minutes before the crash.
The autopsy: The report could not conclusively say whether the heart attack caused the crash or occurred in the moments before or during impact.
Mark emphasized that in the absence of conclusive proof that Steve would have died regardless of the crash, the death should be ruled accidental under the terms of the policy.
The life insurance company’s lawyers pushed back, trying to muddy the waters with medical opinions and vague references to “underlying conditions.” But they couldn’t prove the heart attack was the cause of death.
The Verdict: A Win for the Beneficiary
After weighing the evidence, the court ruled in Stacey’s favor. The judge found that Steve’s death resulted from a qualifying accident—a plane crash during severe weather—and that the AD&D Rider applied. The insurer was ordered to pay the full $1.5 million in accidental death benefits, plus interest.
It was a hard-fought win, but one that made all the difference for Stacey and her children.
Why Life Insurers Fight AD&D Claims
AD&D Riders represent significant financial exposure for insurers. In some cases, payouts can be two or three times the policy’s base value. That gives insurers a strong incentive to look for any reason—no matter how thin—to deny a claim.
Common arguments insurers use include:
The death was due to a medical event, not an accident
The insured had an underlying condition
The death was not sudden or not unintentional
The accident was not covered due to exclusions like substance use or high-risk activity
Often, these arguments are speculative and not grounded in firm evidence. But many grieving families don’t realize they can push back—and win.
What to Do If an AD&D Claim Is Denied
If your claim under an Accidental Death and Dismemberment Rider has been denied:
Request the denial in writing
Get a copy of the full policy, including all riders and exclusions
Gather all medical reports, autopsy results, and accident reports
Speak with a life insurance attorney, especially one familiar with AD&D disputes
Time is of the essence. The sooner you act, the more leverage you’ll have to reverse the denial—or pursue legal action.
We Fight AD&D Claim Denials Nationwide
Our firm specializes in contesting denied life insurance claims, including cases involving AD&D Riders, complex accident investigations, and disputed causes of death. We know the tactics insurers use to minimize or avoid payouts—and we know how to beat them. if you need a beneficiary dispute attorney in South Dakota call today.
If your loved one’s accidental death benefit was denied, contact us for a free consultation. You pay nothing unless we recover for you.