Accidental death and dismemberment (AD&D) policies promise fast, no-questions-asked payouts when the unexpected happens. But behind the scenes, insurers regularly twist the meaning of the word “accident” to fit their financial interests. At our life insurance dispute law firm, we challenge these tactics head-on and fight to get full AD&D benefits paid. If you have a North Carolina life insurance policy dispute call us.
The Silent Denial Strategy: Redefining 'Accident' After the Fact
You’d think the definition of an accident is obvious an unforeseen event that causes injury or death. But AD&D policies often contain restrictive, contradictory, or circular definitions that let insurers reinterpret common events as non-accidental. And if they can reclassify the event, they can deny the claim.
Here’s how it plays out:
A man dies in a fall down the stairs. The insurer claims it was due to a “pre-existing balance issue” and not a true accident.
A woman has a fatal reaction to a bee sting. The insurer calls it a “medical event” and denies accidental death coverage.
A driver is hit by another vehicle. The insurer argues that “alcohol in the system” disqualifies it from being an accident even if the insured wasn’t at fault.
These denials don’t reflect reality. They reflect policy language crafted to avoid paying, and we know exactly how to challenge them.
Real Cases Where AD&D Claims Were Denied Over 'Non-Accident' Disputes
Cardiac Arrest Labeled Natural Causes: A man collapsed after being electrocuted while using faulty machinery. The death certificate listed cardiac arrest. The insurer said it wasn’t an accident—it was “natural.” We obtained forensic reports linking the electrocution to the heart failure and recovered the $250,000 payout.
Drug Interaction Framed as Non-Accidental: A woman took a prescribed medication and suffered a fatal reaction. Her AD&D claim was denied because the insurer claimed she “voluntarily ingested” the substance. We proved the medication was taken as directed and that the reaction was unforeseen—meeting the policy’s own accidental criteria.
Drowning Denied Due to Pre-Existing Epilepsy: A young man drowned while swimming. The insurer argued his seizure disorder meant the death was “medical” and not accidental. We demonstrated that the drowning was caused by an external event water inhalation and that AD&D applied regardless of the underlying condition. The full benefit was paid.
Why 'Accident' Is the Most Dangerous Word in Your Policy
Insurers often write AD&D policies with vague terms like:
“Injury caused solely by external, violent, and accidental means”
“Unforeseen events not contributed to by illness or disease”
“Death must occur within 90 days of the accident”
These definitions give insurers flexibility to deny coverage for anything they can blame on a medical condition, time delay, or internal cause. Even clearly accidental deaths like falls, car crashes, and head injuries can be recast as disqualified events if the insurer believes they can argue a medical factor “contributed.”
We’ve seen deaths by fire, blunt force trauma, and animal attacks all denied under this logic. That’s why it’s critical to challenge the insurer’s interpretation, and to do it with the help of legal professionals who know how these denials are constructed.