We Recovered a $250,000 Denied AD&D Policy—Let Us Help You Win Yours
Our attorneys recently secured $250,000 for a client whose Accidental Death and Dismemberment (AD&D) claim had been wrongfully denied. The insurer argued that the death was not “accidental,” citing a pre-existing condition. After a thorough investigation and legal appeal, we proved that the cause of death met the policy’s definition of an accident. The result? Full recovery of the benefit. If your AD&D claim was denied because the insurer claimed the death was not accidental, you may still be entitled to compensation.
What Counts as an “Accidental Death” in AD&D Policies?
AD&D insurance only pays out if the insured dies due to a qualifying accidental event—such as a car crash, fall, drowning, or other unexpected external occurrence. However, insurers often dispute whether a death was truly accidental. If the death is linked in any way to illness, behavior, or activities excluded in the policy, they may claim the event was not covered. The language in these policies is often broad, ambiguous, and heavily skewed in favor of the insurer, which makes legal review critical when a claim is denied.
10 Common Examples of Deaths Deemed "Not Accidental" by Insurers
1. Death Resulting from a Pre-Existing Medical Condition
If the insured had a known condition—such as heart disease, epilepsy, or diabetes—and died during a seemingly accidental event, the insurer may argue the condition caused the death. For example, if someone dies in a car crash but had a heart attack just before the accident, the claim might be denied for being “natural” rather than accidental.
2. Death Caused by Suicide
Virtually all AD&D policies exclude suicide, whether it’s an intentional act or suspected self-harm. Even if the cause of death is unclear, the insurer may default to this exclusion, requiring the beneficiary to prove it was accidental. This is a frequent area of dispute.
3. Death Caused by Drug or Alcohol Use
If toxicology reports show the insured was under the influence of alcohol or drugs—even legally prescribed ones—the insurer may deny the claim by asserting the substance impaired judgment or directly caused the incident. These denials are often challenged in court, especially when impairment was not the proximate cause.
4. Death Caused by Participating in High-Risk Activities
Many policies exclude deaths caused by extreme sports or recreational risks, such as skydiving, scuba diving, bungee jumping, rock climbing, or off-road racing. Even if the activity was safe and the death was purely accidental, insurers may invoke the high-risk activity exclusion.
5. Death Caused by Criminal Activity
If the insured died while committing or participating in a crime—whether a felony or sometimes even a misdemeanor—the insurer may deny the claim. For instance, a fatal car crash during an unlicensed or reckless drive may fall under this exclusion, even if the crime was minor.
6. Death Caused by Natural Causes
AD&D policies do not cover deaths caused by illness or bodily malfunction, such as strokes, seizures, aneurysms, or heart attacks. If the medical event triggered a fall, drowning, or car accident, the insurer may label the cause as “natural” and deny the claim despite external injuries being involved.
7. Death Caused by Medical Malpractice
If the insured dies due to a surgical error, anesthesia complication, or other form of medical negligence, the insurer may deny the AD&D claim on the grounds that the death was not accidental under the policy’s definition but instead a result of medical treatment or malpractice.
8. Death Caused by a Work-Related Injury
Some AD&D policies exclude coverage if the death is eligible under workers’ compensation. Insurers often deny AD&D claims by asserting that the death is covered under employer-provided benefits, forcing families to seek payment through more complex and time-limited systems.
9. Death Caused by Self-Harm
Even if the insured did not intend to die, any death caused by self-inflicted injury may be excluded. This includes intentional acts of harm, overdoses that appear deliberate, or risky behavior the insurer deems self-destructive. These cases require a strong legal argument to establish true accident versus intentional conduct.
10. Death Caused by an Act of War
AD&D policies commonly exclude deaths resulting from acts of war, terrorism, or military conflict—particularly for those working overseas or in government contract roles. If the insured was traveling in a dangerous zone or working in conflict areas, the insurer may invoke this clause to deny coverage.
AD&D Claim Denials Are Often Wrong—And We Can Fight Them
Insurance companies routinely mislabel accidental deaths to avoid paying benefits. They may hide behind medical jargon, vague exclusions, or unsupported conclusions in a coroner’s report. At our firm, we hold insurers accountable by demanding policy interpretation that favors the insured—especially when the language is unclear or overly restrictive. We work with medical experts, accident reconstructionists, and legal analysts to challenge denials and win full benefits for our clients.
Contact Our Life Insurance Attorneys for a Free Review
If your AD&D claim was denied because the insurer said the death was not accidental, you may still have a strong case. We’ve helped families recover $100,000, $250,000, $600,000 and more from denied accidental death policies. Our legal team is available to review your denial, interpret your policy, and explain your options. Call 800-330-2274 or use the contact form on this page to schedule your free consultation today.
FAQ: Accidental Death & Dismemberment (AD&D) Claim Denials
What is considered an accidental death under an AD&D policy?
An accidental death is typically defined as one caused solely by unforeseen, external, and sudden events—such as a car crash, fall, or drowning. It must not be due to illness, self-harm, or other excluded causes.
Can an insurer deny a claim based on a pre-existing medical condition?
Yes. If the death was linked to a condition the insured had before the policy began, such as a heart attack or seizure, the insurer may claim the death was not accidental.
What if the death involved alcohol or drugs?
Many AD&D policies exclude deaths involving substance use. If the insured was intoxicated, the insurer may argue the behavior was reckless or the cause of death, and deny the claim—even if the accident would have happened anyway.
Does AD&D cover suicide or self-harm?
No. Suicide and intentional self-injury are typically excluded under all AD&D policies, even if the act was not premeditated.
Is a death during surgery considered accidental?
Not under most AD&D policies. Deaths during surgery or due to medical complications are considered medical events, not covered accidents.
Are high-risk hobbies always excluded?
Not always, but many policies exclude extreme activities. It’s important to read the specific exclusions in the policy or consult a lawyer for interpretation.
What if the cause of death is unclear?
If the coroner’s report is ambiguous or leaves room for interpretation, the insurer may default to denial. In these cases, legal help is essential to challenge the findings.
Can I still recover benefits if workers' compensation applies?
Sometimes. If AD&D coverage is separate and not explicitly excluded, both may apply. Insurers often deny AD&D claims in these cases, but this can be fought with legal assistance.
Does the policyholder's intent matter?
Yes. If the insurer believes the insured acted intentionally or engaged in reckless conduct, they may deny the claim. This includes criminal acts or knowingly dangerous behavior.
How can I challenge a denied AD&D claim?
Contact an experienced life insurance attorney. You’ll need to analyze the policy, review the death report, gather evidence, and submit a legal appeal or file suit if necessary.