When a loved one dies unexpectedly, the last thing a family expects is a denied Accidental Death and Dismemberment (AD&D) insurance claim. Yet insurance companies deny these claims regularly, often pointing to policy exclusions or technicalities that seem manufactured. We recently secured a $600,000 payout for a family whose claim was denied due to a substance use exclusion. Our attorneys challenged the denial, and the insurer paid in full. If your AD&D claim was rejected, we may be able to help you recover what you are owed.
What Is AD&D Insurance and Why Do Claims Get Denied?
Accidental Death and Dismemberment insurance pays a benefit when someone dies or suffers severe injury due to an accident. Covered injuries may include loss of life, limbs, vision, or speech. These policies are often added to group life plans or purchased as standalone coverage.
However, AD&D claims are more frequently denied than standard life insurance claims. Insurers rely on complex exclusions and narrow definitions of "accident" to withhold payment. While some exclusions are clearly stated, others are buried in vague language. Many families are blindsided when the insurer finds a reason to deny the benefit, even when the death appears clearly accidental. If you need West Virginia denied life insurance claim guidance call us.
Common Reasons AD&D Claims Are Denied, With Real-World Examples
Death Involving Alcohol Use
A Texas man was killed when he fell from a ladder while cleaning gutters. His blood alcohol level was slightly above the legal limit. The insurer denied the AD&D claim, arguing alcohol contributed to the accident. His family hired us, and we proved the fall was unrelated to impairment. The death was accidental. The full benefit was eventually paid.
Misclassified Medical Emergency
In Ohio, a woman lost control of her car and died in a crash. The insurer denied the AD&D claim, saying the cause was a seizure and not the collision itself. We obtained expert testimony showing the medical issue was speculative. The insurer could not prove a seizure occurred. The family received the full policy amount.
Private Aircraft Exclusion
A business executive in California died in a private plane crash. The AD&D policy contained an exclusion for deaths related to private aviation. However, we showed that the decedent was a passenger on a chartered commercial flight, not a private aircraft. The claim was wrongly denied. After litigation began, the insurer paid $400,000.
Prescription Drug Argument
A New Jersey man died in a motorcycle accident. The toxicology report showed he had taken a prescribed anti-anxiety medication. The insurer used this to argue that the medication impaired him, making the accident non-compensable. We worked with his physician and a pharmacologist to establish that the dosage was consistent and non-impairing. The claim was paid in full after our challenge.
Claim Denied Over "Natural Cause" Classification
A man in Florida drowned after hitting his head while swimming. The insurer argued the cause of death was cardiac arrest and not accidental drowning. We proved that the cardiac arrest resulted from the trauma, not the other way around. The case was settled for the policy maximum.
Technical Denial Reasons That May Be Challenged
Lapsed Policy with Continued Payroll Deductions
In Illinois, a woman was told her AD&D policy had lapsed due to nonpayment. However, her employer continued deducting premiums from her paycheck. We proved the policy should have remained active. The insurer paid the benefit after a demand letter and formal appeal.
Incomplete Documentation Used as Pretext
A Colorado family was denied after their son died in an ATV rollover. The insurer said the accident was not sufficiently documented. We obtained police reports, 911 audio, and witness statements. The claim was resubmitted with our legal brief and paid within 30 days.
Excluded Activity Misapplied
A claim in Arizona was denied after a man died while rock climbing. The policy excluded "hazardous sports," but rock climbing was not listed. We argued the exclusion was too vague and failed to meet the clarity standard required under state law. The insurer reversed its decision before trial.
AD&D Claim Denials Are Not Always Final
Insurers routinely misuse exclusions related to alcohol, drugs, pre-existing conditions, or intentional acts to avoid paying AD&D claims. In reality, many of these denials are based on weak interpretations of the policy language. Our legal team knows how to counter these arguments with clear evidence, expert analysis, and state-specific contract law.
We have reversed AD&D claim denials involving:
Alleged intoxication when accident was unrelated
Accusations of suicide or self-harm with no clear evidence
Mislabeling of natural causes when trauma was involved
Lapse disputes where premium deductions were ongoing
Exclusions improperly applied to common recreational activities
Inconsistent beneficiary information leading to payout delays
These cases often require persistence and aggressive advocacy. We know the tactics insurers use and how to hold them accountable.