$200,000 Accidental Death and Dismemberment (AD&D) Claim Successfully Recovered
We are pleased to announce the recovery of a $200,000 denied accidental death and dismemberment (AD&D) claim for our client. Despite the insurer’s attempt to avoid payment based on exclusionary policy language, our experienced life insurance attorneys challenged the denial, exposed the insurer’s flawed reasoning, and secured the full benefit amount. This case highlights a troubling trend: AD&D claims are increasingly denied based on questionable interpretations of policy exclusions, vague definitions of “accidental death,” and overly broad application of exclusions such as intoxication or criminal activity. Our law firm fights to hold insurers accountable when they unfairly deny claims that grieving families are rightfully owed.
Top 20 Reasons Accidental Death and Dismemberment (AD&D) Claims Are Denied
AD&D policies are designed to pay benefits when a policyholder dies or suffers specific injuries as a direct result of an accident. However, insurers often deny these claims based on fine print and technicalities. Below are the top 20 reasons we see for denied AD&D payouts:
Failure to disclose pre-existing medical conditions – Insurers may claim that a pre-existing condition, rather than an accident, contributed to the death or injury and use that as grounds for denial.
Engaging in hazardous activities or extreme sports – Many AD&D policies exclude coverage for injuries sustained during risky activities like skydiving, racing, or scuba diving.
Intoxication or drug use at the time of the accident – If the insured had alcohol or drugs in their system, insurers frequently invoke intoxication exclusions to avoid paying.
Suicide or self-inflicted injuries – AD&D policies typically exclude intentional self-harm or suicide, even if it was impulsive or occurred during a mental health crisis.
Participating in criminal activity at the time of the accident – Claims may be denied if the accident happened during an illegal act, even if the offense was minor.
Violating traffic laws while driving or operating machinery – Speeding, running a red light, or driving without a license can all be used as justification for denial.
Failure to use appropriate safety equipment or follow safety protocols – Not wearing a seatbelt, helmet, or protective gear may lead to a claim being rejected.
Delay in reporting the accident to the insurance company – Most policies require prompt notice. Delays can give insurers an excuse to deny based on late reporting.
Failure to provide sufficient evidence to support the claim – Lack of documentation, such as police reports or medical records, can lead to denial.
Disputes over the cause or circumstances of the accident – If the insurer believes the event was not truly accidental or involved illness, they may deny the claim.
Failure to seek medical treatment or follow medical advice – Claims involving injury may be denied if the insured didn’t follow up with proper medical care.
Filing a fraudulent claim or providing false information – Any intentional misstatement, even a minor one, can be used to deny the claim outright.
Not meeting the policy's eligibility requirements – If the insured wasn't eligible due to age, employment status, or other restrictions, coverage may not apply.
Lapses in policy coverage due to non-payment or other issues – A missed premium or administrative error can cause coverage to lapse, triggering a denial.
Disputes over the amount of compensation to be paid – Even when claims are approved, insurers may undervalue or misclassify the benefit owed.
Exceeding the policy's maximum benefit amount – Some insurers claim that the injuries or losses do not qualify for the full payout amount.
Disputes over whether the injury or loss was caused by an accident or an illness – If the insurer suspects illness was involved, they may deny the AD&D portion.
Claims made outside the policy's time limit – Policies often include a time window within which claims must be filed. Late claims are often denied outright.
Failure to cooperate with the insurance company's investigation – If beneficiaries fail to provide requested documents or interviews, the claim may be denied.
Denial due to exclusions or limitations in the policy, such as war or acts of terrorism – AD&D policies often exclude certain catastrophic events that involve national or global conflicts.
Don’t Accept an AD&D Denial Without a Fight
If your claim was denied for any of the reasons listed above, don’t give up. Insurers often rely on overly broad exclusions or use speculative interpretations of “accidental death” to avoid paying valid claims. In the case we recently resolved, the insurer tried to argue that the cause of death was not covered because the decedent had traces of alcohol in their system. We demonstrated that the death was still accidental and that the exclusion did not clearly apply. Through aggressive legal advocacy and expert testimony, we forced the insurer to pay the full $200,000 benefit.
Work With Life Insurance Lawyers Who Win
We have successfully recovered millions for clients across the country in both denied life insurance and accidental death claims. Whether your case involves a complex exclusion, a disputed cause of death, or an expired policy, we can help you challenge the denial and get what you’re owed. Our legal team works on contingency—meaning you pay nothing unless we win your case.
If your AD&D or life insurance claim was denied, contact our top-rated life insurance attorneys for a free case evaluation today.