We recently secured a full two hundred thousand dollar Accidental Death and Dismemberment benefit for a family after Fidelity denied their claim based on a trace amount of alcohol found in the decedent’s system. The insurer argued that alcohol use triggered a policy exclusion and that the death therefore did not qualify as accidental. That position did not survive scrutiny. By presenting accident reconstruction evidence, toxicology analysis, and a precise reading of the policy language, we forced the carrier to reverse its denial and pay the claim in full.
Alcohol related denials are among the most common and most abused tactics in AD&D cases. This case illustrates how those denials are built and how they can be dismantled.
How Alcohol Is Used to Deny AD&D Claims
Most AD&D policies contain exclusions for death caused by intoxication, substance abuse, or impairment. What insurers often fail to disclose is that the exclusion typically requires a causal link. The presence of alcohol alone is not enough. The insurer must show that intoxication substantially contributed to the accident and the resulting death.
In this Fidelity claim, the insurer relied on a blood alcohol reading that was below the legal limit and treated it as dispositive. The denial letter assumed impairment without analyzing causation. That assumption became the insurer’s undoing.
Our investigation showed that the fatal injuries resulted from a high speed single vehicle impact that would have been unsurvivable regardless of alcohol presence. Vehicle telemetry, roadway evidence, and damage patterns all confirmed that the collision mechanics, not impairment, caused the death.
Breaking Down the Policy Language
The policy defined accidental death as a loss resulting directly and independently from an accident. The alcohol exclusion applied only if intoxication caused or materially contributed to the accident.
That distinction matters. Many insurers gloss over it.
We forced Fidelity to confront the actual wording. Nowhere did the policy state that any alcohol in the system voided coverage. There was no per se exclusion. There was no numeric threshold. There was only a causation requirement.
Once that language was applied correctly, the denial had no foundation.
Using Expert Evidence to Defeat the Denial
Alcohol based denials are rarely defeated by argument alone. Evidence matters.
In this case we retained an accident reconstruction specialist to analyze scene measurements, vehicle damage, and crash dynamics. The expert concluded that the roadway conditions and vehicle trajectory explained the crash independent of driver condition.
We also retained a forensic toxicologist who explained that the alcohol level detected was consistent with minimal consumption and would not have impaired reaction time or judgment in a way relevant to the accident.
When the insurer continued to resist, we deposed their internal medical reviewer. Under questioning, the reviewer admitted that no analysis had been done to determine whether alcohol actually caused the crash. The denial was based solely on presence, not causation.
That admission effectively ended the dispute.
Common Alcohol Based AD&D Denial Patterns We See
This Fidelity case is not an outlier. Similar tactics appear repeatedly across insurers.
In Ohio, a claim was denied after a man fell from a ladder because toxicology showed alcohol. Medical records and witness statements established he slipped due to a structural defect in the ladder. Once causation was disproven, the claim was paid.
In Arizona, an insurer denied an AD&D claim after a pedestrian was struck by a vehicle while walking home from dinner. Alcohol was detected, but traffic camera footage showed the driver ran a red light. The insurer reversed after being confronted with video evidence.
In Colorado, a skier’s death was denied due to alcohol despite ski patrol reports stating the fall resulted from an avalanche triggered by weather conditions. The insurer abandoned the denial after expert testimony was introduced.
These cases all share the same flaw. Alcohol was present, but it was not the cause.
Why These Denials Persist
Insurers rely on the assumption that beneficiaries will not challenge toxicology findings. Alcohol carries stigma. Families are often reluctant to dispute it, especially while grieving.
Carriers know this. They issue denials that sound definitive but are legally thin. If the beneficiary does not push back, the denial stands.
When challenged with evidence and policy language, many of these denials collapse quickly.
Timing and Procedural Traps in AD&D Claims
Alcohol denials are often paired with procedural pressure. Insurers may delay investigations, request repeated documentation, or assert missed deadlines to increase leverage.
We have overcome denials where claims were rejected for late notice after natural disasters, hospital delays, or insurer miscommunication. Many AD&D policies include extensions or exceptions that carriers conveniently ignore.
In one Texas case, a winter storm delayed reporting. The insurer denied for untimeliness. The policy contained a catastrophe clause allowing extended notice. Once cited, the claim was paid.
Procedural defenses are often as weak as substantive ones when examined carefully.
Why Challenging an AD&D Denial Matters
AD&D benefits are often substantial and separate from standard life insurance. Families who accept an AD&D denial leave significant money on the table, often based on assumptions that do not hold up under review.
Alcohol exclusions are not automatic. Intent exclusions are not presumed. Risky behavior is not the same as excluded conduct. Each denial turns on exact wording and actual causation.
This Fidelity case ended with a full two hundred thousand dollar payout because the insurer could not prove what the policy required them to prove.
Final Takeaway
Alcohol based AD&D denials are frequently issued, often confidently, and often incorrectly. Presence is not causation. Assumption is not proof. Policy language matters.
If an insurer denied your AD&D claim because alcohol was detected, that does not mean the denial is valid. With the right evidence and a precise legal approach, many of these claims can be reversed and paid in full.