Accidental Death and Dismemberment (AD&D) insurance offers an appealing promise: financial protection in the event of a sudden, unexpected tragedy. Whether purchased as a standalone policy, as a rider on a traditional life insurance plan, or even bundled through a credit card benefit, AD&D policies are widespread—and often misunderstood.
Unfortunately, many beneficiaries are blindsided when AD&D claims are denied, leaving them without the payout their loved one intended to provide. Understanding why these claims are denied—and how to fight back—is critical to securing the benefits you’re entitled to. If you need a North Carolina life insurance lawyer call our firm.
Why Insurance Companies Deny AD&D Claims So Frequently
AD&D insurance is relatively inexpensive because accidental deaths are statistically rare. That low frequency of claims makes these policies highly profitable for insurers—as long as they don’t have to pay out. But when an insured person dies in what appears to be an accident, the insurer may suddenly take a different view, carefully scrutinizing the circumstances for reasons to avoid payment.
Insurers have a clear financial incentive to reclassify accidental deaths as something else, especially when payouts exceed $100,000 or more. Denials are often based on creative interpretations of the cause of death, vague policy exclusions, or incomplete investigations. But just because an insurance company denies a claim doesn’t mean the decision is legally justified.
Common Tactics Used to Deny AD&D Claims
1. Misclassifying the Death as Suicide
When an accident results in death—such as a fatal fall, single-vehicle crash, or overdose—insurers often try to label the death as intentional, invoking the suicide exclusion. This tactic is especially common when the cause of death is unclear.
However, under most policies, the burden of proof is on the insurer to show that the death was suicide. Ambiguity should favor the beneficiary—not the insurer. If the insurer can’t provide concrete evidence of intent, the claim should not be denied.
Example: A man died in a single-car accident after leaving work. The insurer denied the claim, calling it suicide. Our legal team uncovered police reports and toxicology data proving otherwise. The family recovered the full AD&D payout.
2. Claiming Death Was Due to Intoxication or Drug Use
Many AD&D policies include exclusions for deaths that occur while the insured is under the influence of drugs or alcohol. If toxicology shows any substance in the system, insurers may argue that impairment caused the accident—and therefore coverage doesn’t apply.
But context matters. Having a drink before dinner or a legally prescribed medication in the system is not the same as being dangerously impaired. Additionally, insurers must prove that the impairment directly caused the accident—not just that it existed.
3. Pre-Existing Condition or Health Event Exclusions
Some AD&D policies exclude deaths resulting from a medical event that led to the accident. For example, if a seizure, heart attack, or stroke caused a fall or car crash, the insurer may argue that the accident was not the primary cause of death.
This tactic often leads to misapplied exclusions—especially if the death occurred due to trauma, not the health episode itself. Insurers sometimes ignore or misinterpret medical evidence to avoid paying out.
How to Fight Back After an AD&D Claim Denial
If your AD&D claim has been denied, don’t assume the insurer’s word is final. Denials are frequently based on incomplete investigations or misinterpretations of medical and legal facts. Here’s what to do:
Request a complete copy of the policy and the denial letter in writing.
Obtain the full claim file, including medical records, accident reports, toxicology reports, and internal claim notes.
Document everything, including communication with the insurance company.
Speak to an attorney who focuses on denied life and AD&D claims.
Time is critical—especially if the policy is governed by ERISA (for employer-sponsored coverage), which often allows only one appeal.
How an AD&D Denial Lawyer Can Help You Recover the Benefits
Fighting an AD&D claim denial is not something most people can do on their own. These cases require legal knowledge, experience with insurance contracts, and access to forensic experts when needed. Our attorneys specialize in contesting AD&D denials and know the tactics insurers use to avoid paying valid claims.
We’ll:
Review your policy and denial letter line-by-line
Investigate the cause of death using independent experts if needed
Rebut weak or unsupported exclusion claims
Prepare and submit a detailed legal appeal or file a lawsuit if required
Our team has overturned denials involving alcohol exclusions, alleged suicides, medical event exclusions, and more. In fact, we’ve recovered millions for families who were told there was “no coverage.”
Don’t Let an AD&D Denial Go Unchallenged
A denied AD&D claim can feel like a dead end—but you have legal rights. The policyholder paid for this protection, and the insurance company has no right to withhold benefits without clear, justifiable cause.
Contact us today for a free consultation. We work on a contingency basis, meaning you pay nothing unless we recover money for you. If your AD&D claim was denied, let us review the facts, expose the insurer’s tactics, and help you secure the benefits your loved one intended for you.