$110,000 Denied Life Insurance Claim Successfully Resolved
Our life insurance claim law firm is proud to announce the successful recovery of a $110,000 denied claim for our client. The denial stemmed from a dispute over whether the death qualified as an “accident” under the policy’s accidental death and dismemberment (AD&D) rider. After a comprehensive investigation and legal advocacy, our attorneys proved that the death met the criteria for coverage and secured the full payout. Cases involving accidental death are often wrongfully denied based on vague exclusions or technical arguments by the insurer. Understanding which types of accidental deaths are frequently disputed can help beneficiaries protect their rights and prepare for potential legal challenges.
What Types of Accidental Deaths Are Commonly Denied by Life Insurance Companies?
AD&D insurance is designed to pay benefits for injuries or deaths caused by unforeseen, unintentional events. However, insurers often deny claims involving accidental death by alleging the cause of death was not “purely accidental,” was complicated by drugs or alcohol, or fell under a policy exclusion. Here are the top categories of accidental deaths that are commonly denied by life insurance companies.
Commonly Disputed Accidental Deaths
Unintentional poisonings and drug overdoses – These are often denied based on intoxication or illegal substance exclusions, even when the overdose was unintentional.
Motor vehicle accidents – If the insured was under the influence, speeding, or allegedly at fault, the insurer may attempt to deny benefits under “reckless behavior” or DUI exclusions.
Falls (including same-level falls and falls from structures) – Denials often occur when insurers claim the fall was due to a medical condition or natural cause rather than an accident.
Suffocation and strangulation in bed – Common in pediatric and elderly cases, these deaths are sometimes denied due to lack of clear external cause or contributory health conditions.
Drowning – If intoxication or seizure activity is involved, insurers may dispute whether the drowning qualifies as accidental.
Fires, burns, and exposure to smoke or flame – Deaths in house fires or accidents involving open flames are often denied if insurers claim negligence or arson.
Medical complications – Accidental deaths resulting from anesthesia errors, surgical mistakes, or medication interactions are frequently denied as “medical in nature” rather than accidental.
Natural disasters – Fatalities from floods, wildfires, or storms may be denied under force majeure or environmental exclusions.
Firearms accidents – These include accidental discharges during cleaning, hunting, or recreational use. Insurers may deny claims based on alleged intentional acts or lack of safety precautions.
Machinery and workplace equipment accidents – These may be disputed under occupational exclusions or improper equipment use clauses.
Air and space transport accidents – Commercial flight deaths are generally covered, but private aviation accidents may be excluded unless disclosed in the application.
Other transportation accidents – Includes train, boat, or ATV crashes, which can be denied if the insured was operating the vehicle improperly or under the influence.
Animal-related accidents – Deaths from animal attacks or accidents involving horses or livestock are sometimes denied based on "hazardous activity" exclusions.
Exposure to electric current, radiation, or extreme temperatures – These may be denied if the exposure occurred at work or under circumstances deemed foreseeable.
Playground equipment or furniture falls – Especially for children or elderly insureds, these incidents may be contested if the insurer argues a pre-existing condition caused the fall.
Stairs, scaffolding, and ladder falls – Insurers often attempt to reclassify these accidents as foreseeable or medically related.
Entrapment or suffocation due to bedding – Often seen in infant and elderly cases, these are denied due to ambiguous cause-of-death determinations.
How Insurers Deny Accidental Death Claims Based on These Events
Insurers frequently deny AD&D claims by:
Arguing the death was caused by a medical issue rather than a traumatic event
Citing intoxication, drug use, or criminal activity exclusions
Claiming that the accident was not sudden or unforeseeable
Asserting that the incident resulted from negligence or voluntary risk-taking
Denying claims due to procedural issues like delayed notification or incomplete documentation
If your claim has been denied based on any of these grounds, it’s important to speak with a life insurance lawyer who can evaluate the policy language, the evidence, and the insurer’s legal obligations.
FAQ: Denied Accidental Death Life Insurance Claims
What qualifies as an accidental death under a life insurance policy?
An accidental death is typically defined as an unexpected, external, and violent event that causes injury or death. However, policies vary, and many contain narrow definitions or exclusions.
Can a drug overdose be considered an accidental death?
Yes, if the overdose was unintentional and not due to illegal or excluded substance use. Many insurers still deny these claims, but they can be challenged with medical evidence and legal analysis.
Are motor vehicle crashes covered under AD&D policies?
Usually, yes—but insurers often deny claims if the insured was intoxicated, unlicensed, or allegedly at fault. These denials can often be disputed.
Can medical complications be considered accidental?
Possibly. If death resulted from an unexpected complication during a routine procedure, it may still qualify as accidental under certain policy definitions.
Does falling at home count as an accidental death?
Yes, if the fall was unexpected and not due to a pre-existing condition. Insurers often deny such claims by arguing the fall was due to age, frailty, or illness.
Are firearm-related deaths covered?
They can be. If the discharge was accidental and not due to suicide, homicide, or illegal activity, the death may be covered. Disputes often arise over intent.
Do accidental deaths involving children qualify for AD&D payouts?
Yes, but insurers may deny claims if they argue the death was due to natural causes or suffocation not clearly proven to be accidental.
Can a workplace machinery accident be denied?
Sometimes. Insurers may point to occupational exclusions or improper use of equipment, but these denials can be contested.
What if the death happened abroad or during travel?
AD&D claims can be denied if the death occurred in a country excluded from coverage or during activities not disclosed at application.
Do I need an attorney to fight a denied accidental death claim?
Yes. Insurers rely on technical language and procedural loopholes. A life insurance lawyer can identify the insurer’s weaknesses and forcefully advocate for payment.