Most people don’t realize that AD&D claims represent a serious financial liability for insurers. For example, if a policyholder has a $400,000 life insurance policy with a 3x AD&D rider, the insurer could be responsible for paying an additional $1.2 million if the policyholder dies in an accident. That’s $1.6 million in total—money the insurance company would much rather keep on its balance sheet.
Because of the high payouts associated with AD&D riders, insurers often search for any justification to avoid paying. They may try to argue:
The death wasn’t truly accidental
The deceased engaged in risky behavior
The policyholder’s actions were “reckless” or “intentional”
An exclusion for certain activities or causes of death applies
Unfortunately, many grieving families accept these denials as final—even when they have no legal merit. That’s a mistake. As life insurance attorneys, we’ve seen AD&D claim denials reversed with the right legal strategy and advocacy.
A holiday tragedy mischaracterized by an insurance company
One of our recent cases involved a man named Rafael—a husband, father of three, and successful mechanical engineer. Through his employer, Rafael had secured a $400,000 life insurance policy with a $1.2 million AD&D rider. He named his wife, Cindy, as the sole beneficiary.
During a large family Thanksgiving celebration, Rafael participated in a long-standing family tradition: a backyard football game. While running a play, Rafael collided head-first with a cousin, resulting in a traumatic brain injury. Despite rapid medical intervention, Rafael died within 30 minutes of the impact.
His death was a heartbreaking shock to the entire family. But in their grief, they found some solace in knowing that Rafael had planned ahead. Cindy submitted a claim for the full $1.6 million policy benefit, expecting the AD&D rider to apply, as Rafael’s death was clearly accidental.
A shocking and unfair denial
Weeks later, Cindy received a letter denying the AD&D portion of the claim. The insurance company’s reasoning? Because Rafael had participated in a "dangerous activity"—football—and did so "without protective gear," they argued his actions were “reckless,” and thus his death did not qualify as accidental.
In other words, they claimed Rafael’s death was partially his fault, and therefore not eligible for AD&D coverage.
This rationale ignored critical facts:
The game was informal and non-contact
Rafael had no history of head trauma or preexisting condition
The death was classified as accidental in every official report
There was no exclusion in the policy for recreational sports
Why insurers make these kinds of arguments
The insurance company wasn’t confused—it was strategic. They assumed Cindy would accept the denial without question. And they counted on the fact that most policyholders and their families don’t know how to challenge a wrongful denial. In truth, this was a classic example of an insurance company manufacturing an excuse to avoid a large payout.
Legal intervention changes everything
Fortunately, one of Rafael’s cousins was an attorney. He referred Cindy to a colleague who specializes in contesting denied life insurance and AD&D claims. That attorney took immediate action.
After reviewing the full file, the attorney prepared a legal appeal package that included:
Hospital records and the coroner’s report identifying the death as accidental
Witness statements from family members present at the game
Case law demonstrating that recreational sports injuries have been consistently treated as “accidental” for insurance purposes
A strongly-worded legal brief contesting the claim denial under applicable insurance regulations and contract law
The appeal was submitted to the insurance company’s internal appeals board. After several follow-up calls—and with the attorney’s established reputation for litigation success—the insurer backed down and approved the full payout. If you want to know how to appeal a life insurance denial in New York call us.
What this case illustrates
This case underscores a troubling truth: insurance companies routinely deny large AD&D claims based on flimsy logic and self-serving policy interpretations. Without an attorney’s intervention, Cindy might never have received the additional $1.2 million that Rafael wanted her and their children to have.
If you received a denial on an AD&D claim, don’t walk away. Get legal help.
AD&D riders are meant to offer peace of mind—not loopholes for insurers. If your claim has been denied, especially with vague reasoning like “recklessness,” “excluded activity,” or “non-accidental death,” it’s time to talk to a lawyer.
Our law firm works exclusively on life insurance claim denials, including those involving accidental death riders. We know how to challenge false narratives, push back on bad faith tactics, and get insurers to pay what they owe.
We offer free consultations and work on a contingency basis—meaning you pay nothing unless we recover money for you.