$525,000 Denied Life Insurance Claim Successfully Resolved
Our life insurance law firm is proud to announce the successful recovery of a $525,000 denied life insurance claim on behalf of our client. The claim, which involved accidental death and dismemberment (AD&D) coverage, was initially denied by the insurer based on a disputed policy exclusion. After conducting a thorough policy review and legal challenge, our attorneys overturned the denial and secured the full payout. This case illustrates how insurers frequently deny AD&D claims based on narrowly interpreted or ambiguous exclusions. If your AD&D claim was denied, we can help you fight back and recover what you’re owed.
What Is Accidental Death and Dismemberment Insurance?
Accidental death and dismemberment (AD&D) insurance provides financial benefits when an insured dies or suffers a serious injury due to a qualifying accident. It is commonly offered as a standalone policy or as a rider on a life or health insurance policy. While AD&D coverage is valuable, insurers often apply strict criteria to determine what qualifies as an “accident” and may deny claims based on exclusions or procedural errors. Understanding why these claims are denied is essential to pursuing a successful appeal.
30 Reasons Why Accidental Death and Dismemberment Claims Are Denied
The death or injury was not caused by an accident. If the insurer determines the cause was illness or a natural condition, the claim may be denied.
The policy was not active at the time of the accident. If coverage had lapsed or expired, benefits may be denied.
The accident falls under one of the policy’s listed exclusions. These may include specific activities, conditions, or scenarios.
Premiums were not paid, resulting in a policy lapse. Without active coverage, no claim can be approved.
The insured failed to disclose a pre-existing condition. If a medical condition contributed to the injury, the insurer may challenge the claim.
The death or injury was self-inflicted. Suicide or intentional harm is excluded under most AD&D policies.
The insured was under the influence of drugs or alcohol at the time of the incident. Intoxication exclusions are common.
The injury or death occurred during criminal activity. Participation in illegal acts voids coverage in many policies.
The incident occurred during extreme sports or high-risk activities. Activities like skydiving or mountaineering may be excluded.
The death occurred in a war zone or military conflict. Most policies exclude coverage for war-related casualties.
The insured died while committing a felony. Felonious conduct typically voids accidental death coverage.
The incident occurred during a riot or civil unrest. Civil commotion is a common exclusion in AD&D policies.
The death was caused by terrorism. Some policies exclude acts of terrorism, especially abroad.
The cause of death was due to natural causes. If the death was not directly caused by a traumatic event, it is not covered.
Insufficient evidence of an accident was provided. A lack of proof may prevent claim approval.
The injury or death occurred outside the geographical coverage area. Some policies limit coverage to certain regions or countries.
The claim was filed after the policy expired. Late filings outside of policy terms may lead to automatic denial.
No insurable interest existed between the policyholder and insured. This can invalidate the contract.
The policyholder lacked legal authority to purchase the policy. Unauthorized purchases may be deemed invalid.
The policyholder was not a named beneficiary. Only named beneficiaries can collect under the policy.
The beneficiary did not have an insurable interest. This is required in some jurisdictions at policy inception.
The beneficiary was not named in the policy. Without a designated beneficiary, claims can be delayed or denied.
The named beneficiary had predeceased the insured. If no alternate beneficiary is listed, the benefit may default to the estate.
The beneficiary was a minor and no guardian or trustee was designated. This can delay or complicate the claim process.
The beneficiary was not a legal resident at the time of the insured’s death. Residency restrictions may apply under some policies.
The beneficiary had no legal or familial relationship to the insured. Some policies limit payout to related parties.
The beneficiary’s name was recorded incorrectly. Errors in documentation can delay or invalidate a claim.
The policyholder failed to follow the required claims procedures. Missing forms or incomplete submissions may result in denial.
The insurer was not notified of the accident within the required time frame. Most policies require prompt notice of claim.
The incident occurred before the waiting period expired. Some policies impose a waiting period before AD&D coverage begins.
Insurers often deny AD&D claims based on interpretations that favor the company—not the policyholder. If your claim has been denied for any of the reasons above, legal review may uncover policyholder rights that the insurer has overlooked or intentionally ignored.
FAQ: Denied Accidental Death and Dismemberment Claims
Can an insurer deny an AD&D claim if the cause of death was illness-related?
Yes. AD&D policies only cover accidental deaths, so deaths due to illness, stroke, or heart attack may be excluded unless triggered by a traumatic event.
What qualifies as an accident under AD&D coverage?
An accident is generally defined as an unexpected, external, and violent event. However, each policy may define it differently. Legal review is crucial when disputes arise.
Can intoxication void an AD&D policy claim?
Yes. Most policies include intoxication exclusions. If drugs or alcohol contributed to the death or injury, insurers may deny the claim.
What happens if the insured died during a high-risk activity?
If the activity—such as skydiving or racing—is excluded under the policy, the claim may be denied even if it was truly accidental.
Is military service a common exclusion for AD&D policies?
Yes. Many policies specifically exclude coverage for injuries or death that occur during active military duty or war.
What should I do if the claim was denied for lack of evidence?
Gather all accident reports, medical records, and witness statements. An attorney can help build a case to overturn the denial.
Can a minor be a life insurance beneficiary?
Yes, but without a designated trustee or guardian, payouts can be delayed or diverted to the estate. Legal intervention may be necessary.
Is late claim notification a valid reason for denial?
It can be, but insurers must show that the delay prejudiced their ability to investigate. Courts often allow reasonable extensions.
Can a beneficiary’s residency status affect the claim?
In rare cases, yes. Some policies require beneficiaries to be legal residents, especially in international policies.
Do I need an attorney to appeal a denied AD&D claim?
Yes. Insurers have legal teams dedicated to defending claim denials. An experienced lawyer can analyze the policy, develop legal arguments, and pursue recovery through appeal or litigation.