Our firm recently secured full payment of a $110,000 life insurance claim after Globe Life denied benefits under an accidental death and dismemberment rider. The insurer claimed the death did not qualify as an “accident” under the policy definition and attempted to reclassify the event using narrow and selective language. After a detailed investigation and targeted legal challenge, we proved the denial was unsupported and forced payment of the full benefit.
Accidental death denials like this are common. AD&D riders are heavily marketed as straightforward coverage, but insurers routinely reinterpret accidents after the fact in order to avoid paying claims. Understanding which types of accidental deaths are most often disputed helps beneficiaries recognize when a denial is likely improper.
Why Accidental Death Claims Are Frequently Denied
AD&D coverage only applies when death results from a sudden, external, and unintended event. Insurers take advantage of that requirement by attempting to insert medical, behavioral, or circumstantial explanations that shift the cause of death away from the accident itself.
Rather than focusing on what physically caused the fatal injury, insurers often focus on contributing conditions, background facts, or speculative explanations. If they can argue the death was not purely accidental, they deny the claim.
In the Globe Life case, the insurer relied on selective policy language and ignored the actual mechanics of the fatal event. Once confronted with evidence and policy interpretation under controlling law, the denial could not stand.
Categories of Accidental Deaths Commonly Disputed by Insurers
Certain types of accidental deaths are denied far more often than others. These denials tend to follow predictable patterns.
Falls and Impact Injuries
Falls inside the home, from stairs, ladders, decks, balconies, or furniture are frequently denied. Insurers often argue the fall resulted from a medical issue such as dizziness, weakness, or age-related frailty rather than an accidental hazard. These arguments are commonly speculative and unsupported by medical evidence.
Motor Vehicle Accidents
Car, motorcycle, ATV, and boat crashes are often denied if the insurer alleges intoxication, speeding, distraction, or fault. Many policies do not exclude accidents based on fault, yet insurers attempt to import negligence concepts into AD&D analysis.
Drowning Incidents
Drownings are frequently reclassified as medical deaths. Insurers may claim the insured suffered a seizure, cardiac event, or loss of consciousness before entering the water. Unless supported by clear medical proof, these denials are often improper.
Unintentional Overdoses and Poisonings
Accidental overdoses involving prescription medication, medication interactions, or incorrect dosing are often denied under intoxication or illegal substance exclusions. Many of these deaths are unintentional and qualify as accidental under the policy when exclusions are narrowly construed.
Fires, Burns, and Smoke Inhalation
Deaths caused by house fires, faulty wiring, heaters, or cooking accidents are sometimes denied based on alleged negligence, arson speculation, or policy language suggesting the event was foreseeable. Foreseeability is not the same as intent and is often misused.
Medical Procedure Complications
Unexpected deaths caused by anesthesia errors, medication reactions, or surgical complications are often labeled as medical rather than accidental. Whether these qualify depends on how the policy defines accident and injury. Many such denials are contestable.
Suffocation and Entrapment
Suffocation involving bedding, furniture, machinery, or confined spaces is frequently disputed, especially in cases involving children or elderly insureds. Insurers often rely on ambiguous death certificates or incomplete investigations.
Firearm Accidents
Accidental discharges during cleaning, storage, or recreational use are often denied based on assumed intent or unsafe handling. When evidence shows the discharge was unintended, coverage may still apply.
Machinery and Equipment Accidents
Deaths involving forklifts, industrial equipment, farm machinery, or power tools are often denied under occupational exclusions or improper use arguments. These exclusions are often narrowly drafted and frequently misapplied.
Animal-Related Accidents
Fatal injuries involving horses, livestock, dogs, or wildlife are often denied under hazardous activity language, even when the insured was not engaged in a risky activity at the time of injury.
How Insurers Justify These Denials
Insurers tend to rely on a small set of recurring arguments:
Reclassifying the death as medical rather than accidental
Alleging intoxication without proving causation
Claiming the event was foreseeable or voluntary
Applying exclusions beyond their intended scope
Relying on incomplete investigations or assumptions
Using procedural issues such as notice timing or documentation gaps
Many of these justifications collapse when examined closely against the actual policy language and the facts.
What Makes Accidental Death Denials Vulnerable to Challenge
Accidental death claims are highly fact-driven. Insurers often deny first and analyze later. Once evidence is gathered, inconsistencies appear.
Successful challenges often focus on:
The physical cause of the fatal injury
Whether exclusions require causation or mere presence
Undefined or ambiguous policy terms
Lack of medical proof supporting alternative explanations
Insurer reliance on assumptions rather than evidence
Courts generally interpret ambiguous AD&D language in favor of coverage. Insurers know this, which is why many disputes resolve once legal pressure is applied.
Key Takeaway for Beneficiaries
A denial under an accidental death rider does not mean the claim lacks merit. Insurers routinely deny valid AD&D claims by stretching definitions and ignoring inconvenient facts. The $110,000 Globe Life recovery is one example of how these denials can be reversed when the policy language and evidence are properly examined.
If an accidental death claim has been denied because the insurer says the death was not truly accidental, the denial deserves close scrutiny. Many of these decisions do not survive a thorough legal challenge.