When a loved one dies unexpectedly, families expect life insurance to provide the support it promised. But in many cases involving Accidental Death and Dismemberment (AD&D) policies, insurers deny claims by arguing the death was not truly an accident. That’s what happened to one of our clients—until we stepped in and secured the full $250,000 benefit.
The insurer initially claimed the man’s fall was caused by a heart condition. Our attorneys brought in medical experts, challenged the policy interpretation, and forced the insurance company to pay. If your claim was denied for similar reasons, we can help. If you need a Washington life insurance lawyer call us.
What Is Considered an “Accidental Death” in AD&D Insurance?
AD&D policies only pay when death results from a sudden, external, and unintended event. Examples include car crashes, fatal falls, electrocutions, and drownings. However, the definition of an accident is not always clear, and insurance companies take full advantage of that ambiguity.
Many insurers stretch policy exclusions to argue that a death was caused by illness, reckless behavior, or intoxication rather than an accident. This is where most denials originate—and where legal intervention often makes the difference.
10 Real Examples of Wrongfully Denied AD&D Claims
1. Fall During Roof Repairs
A man in Pennsylvania fell from his roof while fixing a gutter. The insurer denied the claim, suggesting the act was too risky to be covered. We submitted testimony from a contractor and safety inspector who confirmed it was a routine home maintenance task. The full payout was made to his spouse.
2. Drowning Labeled a Medical Event
A college student in Michigan drowned during a weekend lake trip. The insurance company pointed to a speculative seizure and called the cause of death "natural." We showed there was no medical history or diagnosis of epilepsy. After an appeal supported by expert review, the family received the full $300,000 benefit.
3. Motorcycle Crash Involving Prescription Medication
In Nevada, a man died in a motorcycle accident. The toxicology report revealed a low level of prescribed anxiety medication. The insurer argued it impaired his ability to drive safely. We proved through medical records that he was stable and compliant with treatment. The denial was reversed.
4. Workplace Accident Denied Due to Compensation Conflict
A construction worker in Georgia was killed by heavy machinery. His employer provided workers’ comp coverage, but the insurer used that as a reason to deny the AD&D claim. We demonstrated that the policy did not exclude overlapping benefits. The insurance company settled for the full policy limit.
5. Electrocution During Home Renovation
In Florida, a father died while installing a ceiling fan. The insurer said the risk was foreseeable and refused to pay. We countered with expert testimony that the accident stemmed from faulty wiring behind a sealed wall. His family recovered the full benefit.
6. Slip and Fall Dismissed as Illness-Related
A woman in Illinois fell down her basement stairs and died from a head injury. The insurer claimed she had a fainting episode due to a medical issue. We reviewed the autopsy report and found no such evidence. Her adult children received the full $250,000 benefit after we filed a formal appeal.
7. Hiker Crushed by Falling Rocks
In Arizona, a man was killed while hiking with friends. The insurer denied the claim, calling the activity dangerous and excluded. The policy listed specific exclusions but did not mention hiking. We used that omission to challenge the vague wording, and the claim was paid.
8. Crash Involving Low-Level Alcohol Content
A man in California died in a single-vehicle accident. His blood alcohol level was 0.03, well under the legal limit. The insurer denied the claim based on alcohol presence alone. We showed that the cause of the crash was a mechanical issue with the vehicle, not impairment. Full benefits were recovered.
9. Dental Procedure Gone Wrong
In New York, a man aspirated gauze during a routine dental cleaning and died shortly after. The insurer labeled the death as medical error rather than an accident. We argued that the event involved external trauma, not a medical condition. The denial was overturned.
10. Death During Recreational ATV Ride
A man was thrown from an all-terrain vehicle while riding with friends on public trails. The insurer pointed to a high-risk activity exclusion. We reviewed the policy and proved that ATV riding was not specifically excluded. After negotiations, the insurer agreed to pay in full.
Why AD&D Denials Often Get It Wrong
Insurance companies routinely rely on vague policy terms and questionable interpretations to deny accidental death claims. If they can blame a medical issue, risky behavior, or substance involvement, they will. Often, these conclusions are based on assumptions rather than facts.
Our firm works with medical experts, policy analysts, and accident investigators to dismantle those arguments. We review the exact language of your policy, apply relevant state law, and pressure insurers to honor the coverage that was purchased.
What You Should Do if Your Claim Was Denied
Do not accept the insurer’s explanation without question. Many AD&D denials are flawed and legally challengeable. We offer free consultations to review your denial letter, policy language, and the surrounding facts.
If we take your case, you pay nothing unless we recover money for you. Our team has recovered millions for families who were told their claims didn’t qualify. Whether the insurer cited alcohol use, medical conditions, or policy exclusions, we can evaluate and fight for the benefits you deserve.