We Recovered a $600,000 Denied AD&D Life Insurance Claim—We Can Help You Too
Our life insurance attorneys recently won a $600,000 denied Accidental Death and Dismemberment (AD&D) claim for a family that was wrongfully denied the benefits they were promised. The insurer had cited an exclusion related to substance use, but our legal team successfully challenged the decision and forced a full payout. If your AD&D claim was denied, you may still be entitled to benefits. Insurance companies often misuse exclusions or procedural errors to avoid payment—but we know how to fight back.
What Is AD&D Insurance and Why Are Claims Denied?
Accidental Death and Dismemberment insurance is a supplemental form of coverage that pays a benefit when a person dies or suffers a severe injury—such as the loss of a limb, vision, or speech—due to a qualifying accident. However, these policies are notoriously restrictive, and insurers frequently deny claims by pointing to exclusions, lapses, or other technicalities. Understanding the most common reasons AD&D claims are denied can help beneficiaries recognize when they need legal help.
Top 10 Reasons AD&D Life Insurance Claims Are Denied
1. Policy Exclusions
AD&D policies are filled with exclusions that limit what is considered a “covered accident.” Deaths from high-risk activities like skydiving, base jumping, motorcycle racing, or private aviation may be explicitly excluded. Insurers may also exclude death due to war, suicide, or certain occupational hazards. If the insured dies during an excluded activity, the claim may be denied—even if it was truly accidental.
2. Failure to Disclose Pre-Existing Medical Conditions
If the policyholder failed to disclose a pre-existing condition—such as epilepsy, heart disease, or diabetes—and the death is later linked to that condition, the insurer may argue that the incident was not accidental but due to natural causes or an underlying health issue. This is a common tactic used to reject otherwise valid claims.
3. Intentional Acts
AD&D policies do not cover self-inflicted injuries or suicide. If the insurer concludes that the insured intended to cause their own death or harm, the claim will be denied. Even ambiguous situations—such as single-vehicle accidents or overdose deaths—can be improperly categorized as intentional, placing the burden on the beneficiary to prove otherwise.
4. Alcohol or Drug Use
Many AD&D policies contain substance-related exclusions. If toxicology reports show that the insured was under the influence of alcohol or drugs—even prescription medication—the insurer may argue that the impairment caused or contributed to the accident and deny the claim. These denials often require legal challenge, especially when impairment was not the primary cause of death.
5. Policy Lapse
If premiums were not paid and the policy lapsed prior to the accident, the claim will be denied. However, insurers sometimes fail to notify the policyholder of the lapse or continue deducting premiums without applying them properly. In those cases, we’ve been able to prove the policy was still in force and secure payment for our clients.
6. Lack of Documentation
AD&D claims require proof that the death or dismemberment was directly caused by an accident. Missing or incomplete documentation—such as police reports, autopsy records, toxicology screens, or eyewitness statements—can lead to delays or outright denial. We assist clients in gathering and submitting the required documentation to challenge denials based on alleged insufficiency.
7. Non-Accidental Death
AD&D only pays when the cause of death is strictly accidental. If the death was due to a medical event like a stroke, heart attack, or aneurysm—even if it occurred while driving or falling—the insurer may label it as natural and deny the claim. Legal intervention may be needed to prove the death was accidental in nature.
8. Exceeding Benefit Limits
Some policies have caps on payouts for certain injuries or accidents. For example, the policy may cover up to $100,000 for loss of one limb and $250,000 for death. If the claim exceeds those caps, the excess may be denied. However, insurers sometimes miscalculate benefits or apply the wrong formula—another issue we can contest.
9. Ineligible Beneficiaries
If the named beneficiary is deceased, has been disqualified due to legal reasons, or was never formally designated, the insurer may withhold payment or initiate an interpleader lawsuit. These disputes often require court intervention and legal guidance to ensure the rightful party receives the benefit.
10. Policyholder’s Age
Some AD&D policies limit coverage based on age. For example, coverage may reduce after age 65 or end altogether after age 70. If the insured was outside the covered age range at the time of death, the insurer may deny the claim entirely. However, such denials may be legally challenged if the insurer failed to disclose or apply the policy terms properly.
AD&D Claims Are Often Denied—But Can Be Reversed
Accidental death claims are some of the most frequently denied life insurance benefits due to the narrow definitions and broad exclusions in these policies. But a denial doesn’t mean you’re out of options. Our life insurance attorneys have overturned AD&D denials from major insurers including MetLife, Prudential, AIG, Mutual of Omaha, and Lincoln Financial. We investigate every case, review the policy language, gather expert reports, and challenge insurers who rely on vague exclusions or incomplete investigations to deny benefits.
Contact Our Life Insurance Attorneys Today
If your AD&D claim was denied, don’t wait. These cases often involve short deadlines and complex appeals. Our firm handles life insurance denials on a contingency basis—you don’t pay unless we win. Call us now at 800-330-2274 or use the contact form for a free consultation.
FAQ: Denied Accidental Death & Dismemberment (AD&D) Claims
What is an AD&D insurance policy?
An Accidental Death and Dismemberment policy pays a benefit when the insured dies or suffers serious injury due to a qualifying accident. It’s often a rider on a regular life insurance policy or part of a group benefits package.
Does AD&D insurance cover all accidental deaths?
No. AD&D policies contain exclusions for certain activities, health-related incidents, drug or alcohol use, and intentional acts. Not all accidental deaths are considered “covered” under the policy.
Can a claim be denied if drugs or alcohol were involved?
Yes. If the insured was impaired at the time of the accident, many insurers will argue that the substance use contributed to the death and use that as a reason to deny the claim.
What if the death was partially related to a medical condition?
If the insurer believes a medical issue—such as a heart attack or seizure—caused the accident, they may classify the death as natural and deny the AD&D claim. This can often be disputed with expert medical analysis.
What if the insured wasn’t at fault in the accident?
Fault is not always the issue. The key question is whether the cause of death meets the definition of an “accident” under the policy and whether any exclusions apply.
How long does it take to resolve a denied AD&D claim?
It varies. Some cases are resolved within weeks after a strong legal appeal. Others, especially those involving disputed cause of death or interpleader lawsuits, may take several months.
Can I sue the insurance company if my claim was denied?
Yes. If the insurer wrongfully denied your claim or acted in bad faith, you can file a lawsuit to enforce the policy and recover the full benefit—plus potential legal costs.
Does AD&D cover death during travel or work?
Sometimes. Many group AD&D policies cover accidental death during work-related activities or business travel, but specific exclusions and coverage conditions may apply.
What if the policy lapsed before the death?
If the policy was inactive, the claim may be denied. However, if the lapse was due to employer error, missed notices, or automatic premium deductions not being processed, the denial can often be challenged.
Can a lawyer help with a denied AD&D claim?
Absolutely. Life insurance attorneys understand how to interpret policy exclusions, build a strong case, and force insurers to pay denied claims. Legal help often makes the difference between rejection and recovery.