Our firm recently recovered a four hundred thousand dollar Accidental Death and Dismemberment benefit after American General denied the claim by reclassifying a clearly accidental death as a non-accidental event. The insurer relied on a strained interpretation of policy language to argue that a medical factor contributed to the death, even though the fatal injury resulted from a sudden external event. After a detailed factual investigation and policy analysis, we forced American General to reverse the denial and pay the full AD&D benefit.
This case highlights one of the most common and least understood denial tactics in AD&D claims. Insurers often do not dispute that an injury occurred. Instead, they quietly redefine what qualifies as an “accident” after the fact.
How AD&D Insurers Redefine Accidents to Avoid Paying Claims
Most people assume an accident means an unexpected event that causes injury or death. That is how policyholders understand it when they purchase coverage. But AD&D policies are drafted with technical definitions that allow insurers to argue that many everyday accidents are not accidents at all.
In practice, insurers look for any medical condition, substance, or internal factor they can claim contributed to the death. Once they argue contribution, they assert that the death was not caused solely by accidental means and deny the claim.
In the American General case, the insured suffered a fatal injury during an unexpected incident. Rather than disputing the injury itself, the insurer argued that an underlying health condition may have played a role in the outcome. That single assertion became the basis for denying the entire AD&D benefit.
The Silent Denial Strategy Used in AD&D Claims
This type of denial rarely appears dramatic on paper. It is framed as a technical interpretation of policy language rather than a flat refusal to pay. Beneficiaries are often told that the death does not meet the policy definition of accidental because something internal may have contributed.
Here is how insurers typically apply this strategy.
A fall is blamed on a balance disorder rather than the impact
A drowning is blamed on a seizure history rather than water inhalation
A car crash is blamed on medication or alcohol rather than the collision
A fatal allergic reaction is labeled a medical event rather than an accident
The insurer does not need to prove intent or wrongdoing. They only need to argue that the accident was not the sole cause of death.
Real AD&D Denials Based on Reclassified Accidents
We regularly see AD&D claims denied using this exact approach.
Falls Reframed as Medical Events
A person slips on stairs, falls, and suffers fatal head trauma. The insurer points to diabetes, vertigo, or blood pressure issues and claims the fall was medically caused rather than accidental. In many cases, there is no evidence that a medical episode occurred, but the insurer relies on speculation.
Courts often reject this reasoning when the injury itself is clearly accidental.
Drownings Labeled Illness-Related
Insurers frequently deny drowning claims by alleging seizures, cardiac events, or loss of consciousness occurred first. Even when the medical examiner lists drowning as the cause of death, insurers attempt to shift focus to underlying conditions.
AD&D coverage typically applies when death results from an external event like water inhalation, regardless of why the person entered the water.
Vehicle Accidents Disqualified by Toxicology
Even trace amounts of alcohol or prescription medication are often used to deny AD&D benefits. Insurers argue that the presence of any substance means the death was not accidental.
In many cases, accident reconstruction and toxicology evidence proves the crash would have occurred regardless of substance levels.
Electrocutions and Machinery Injuries Recast as Natural Causes
When electrocution or industrial accidents lead to cardiac arrest, insurers sometimes argue that the heart failure was natural rather than injury-induced. This ignores the role of external trauma in triggering the fatal event.
Medical causation evidence is critical in these disputes.
Why the Definition of “Accident” Is So Dangerous in AD&D Policies
AD&D policies often include phrases such as:
Injury caused solely by accidental means
Death not contributed to by illness or disease
Unforeseen events independent of all other causes
Death occurring within a specified time after injury
These clauses give insurers wide latitude to deny claims whenever they can argue contribution, delay, or internal causation. Even common accidental deaths can be excluded if the insurer applies these phrases aggressively.
The problem is that most policies do not define how much contribution is too much. They also fail to explain whether pre-existing conditions automatically disqualify coverage. This ambiguity is where insurers operate.
How We Challenged the American General Denial
In the four hundred thousand dollar American General case, we focused on three core issues.
First, we established that the injury was sudden, external, and unintended.
Second, we showed that the insurer could not prove a medical event occurred before the injury.
Third, we demonstrated that the policy language did not exclude coverage simply because a health condition existed.
By forcing the insurer to rely on evidence rather than speculation, their denial position collapsed. Once confronted with expert analysis and a clear reading of the policy, American General reversed course and paid the full AD&D benefit.
Why These Denials Are Often Winnable
AD&D denials based on accident reclassification often look authoritative but rest on weak foundations. Insurers assume beneficiaries will not challenge medical causation arguments or policy definitions. When those assumptions are tested, many denials fail.
These cases turn on facts, medical timelines, and the precise wording of the policy. When insurers stretch definitions beyond what the contract reasonably allows, courts and regulators often side with beneficiaries.
Do Not Accept an AD&D “Not an Accident” Denial at Face Value
If an AD&D claim is denied because the insurer claims the death was not accidental, that is not the end of the analysis. These denials are frequently based on speculation, vague language, or internal medical reviews that ignore real-world facts.
The four hundred thousand dollar American General recovery shows how powerful this denial tactic is and how vulnerable it becomes when properly challenged. If an insurer is redefining an obvious accident to avoid paying benefits, the claim deserves careful legal review.