$2 Million Life Insurance Claim Denial Reversed by Our Law Firm
We are proud to share that our life insurance attorneys recently resolved a $2 million denied life insurance claim for one of our clients. The insurance company had attempted to avoid payment by alleging that the policyholder’s death was not truly “accidental.” After conducting a detailed investigation and filing a strong legal appeal, we successfully overturned the denial and secured the full payout. If your Accidental Death and Dismemberment (AD&D) claim has been denied, don’t give up—our law firm has a proven track record of winning these complex cases.
Accidents That May Lead to a Denied AD&D Life Insurance Claim
AD&D policies are known for having strict and narrow definitions of what qualifies as an “accidental” death. Insurers often rely on exclusions and policy language to avoid paying beneficiaries, even in situations that seem clearly accidental. Below are 20 types of accidents that commonly lead to denied AD&D claims—often requiring legal intervention to dispute.
1. Suicide
Suicide is expressly excluded under virtually all AD&D policies. If the death was ruled intentional, the insurer will deny the claim—even if the family believes it was accidental or the result of a mental health crisis.
2. Self-inflicted injuries
If the insurer believes the injury or death resulted from intentional self-harm, even if not suicidal, the claim may be denied. This includes cases involving high-risk behaviors or self-endangerment.
3. Injuries sustained while under the influence of drugs or alcohol
If the insured was intoxicated or had drugs in their system—prescription or otherwise—at the time of the accident, the insurer may claim the impairment contributed to the death and deny coverage under a substance exclusion.
4. Accidents resulting from participation in illegal activities
If the policyholder was engaged in illegal conduct at the time of the accident—such as trespassing, street racing, or drug distribution—the insurer may invoke the crime exclusion and deny the claim.
5. Accidents resulting from participation in extreme sports or high-risk activities
Activities like base jumping, skydiving, or off-road racing are frequently excluded from coverage. Even if performed recreationally, these hobbies are often listed in policy exclusions.
6. Accidents that occur while the policyholder is committing a crime
Death or injury that occurs while the insured is actively committing a crime—whether a felony or misdemeanor—can void the claim. This can include theft, assault, or even fleeing arrest.
7. Injuries sustained while the policyholder is engaged in a dangerous hobby or pastime
Dangerous hobbies, such as flying private planes, scuba diving, or operating heavy machinery for recreation, may fall outside the scope of covered accidents.
8. Injuries sustained while the policyholder is driving under the influence
If the insured was intoxicated while driving and died in a crash, insurers often deny the AD&D claim under both substance and illegal behavior exclusions.
9. Accidents caused by the policyholder’s intentional or reckless actions
If the death occurred due to recklessness—such as playing with firearms, ignoring safety warnings, or provoking violence—the insurer may argue the actions were intentional or foreseeable and therefore not accidental.
10. Injuries sustained as a result of medical complications related to a pre-existing condition
If a medical issue—like a seizure or heart problem—triggered the accident, the insurer may deny the claim by stating the death was caused by illness rather than a covered accident.
11. Injuries or death caused by a pre-existing health condition, such as a heart attack or stroke
If a health condition directly led to the death, even during an activity that seems accidental (like falling or crashing), the claim may be rejected.
12. Injuries sustained while the policyholder is in a war zone or conflict area
Traveling to or residing in regions with active conflict or war often voids coverage. Some policies exclude not just combatants but also civilians in affected areas.
13. Injuries sustained while participating in military service or training
Service-related injuries or deaths are frequently excluded from AD&D coverage, especially if another federal benefit applies (such as SGLI or VA benefits).
14. Injuries sustained as a result of a terrorist attack or act of war
Some policies exclude deaths related to terrorism or war—particularly in cases where the insured was overseas or working for a government contractor.
15. Injuries sustained while attempting to commit a crime
Even if the act was not completed—such as an attempted robbery or assault—the act of attempting a crime can void the policy’s accidental coverage.
16. Accidents that occur while the policyholder is engaging in autoerotic asphyxiation
Deaths resulting from autoerotic activities are often denied as either self-inflicted or due to risky, foreseeable behavior.
17. Injuries sustained during a fight or altercation
If the policyholder initiated or engaged in a physical fight, the insurer may deny the claim by arguing the event was not unforeseen and falls under intentional or criminal exclusions.
18. Injuries sustained while the policyholder is attempting to flee from law enforcement
Deaths during police pursuits or arrests are commonly denied, as they are seen as resulting from criminal acts or reckless behavior.
19. Injuries sustained as a result of failing to follow safety guidelines or instructions
If the insured ignored posted warnings, failed to wear safety equipment, or violated known protocols, the insurer may argue the injury was due to negligence—not an accident.
20. Injuries sustained while the policyholder is violating traffic laws or driving recklessly
Speeding, running red lights, or dangerous lane changes can all be viewed as reckless or intentional behavior—potentially disqualifying the incident from AD&D coverage.
We Know How to Challenge AD&D Denials—and Win
AD&D claim denials are often unjust, overly broad, or based on biased assumptions. Insurers frequently cite exclusions without proving they apply. Our legal team carefully examines the facts, disputes the insurer’s interpretation, and holds them accountable under the law. Whether your claim was denied for alleged intoxication, a risky activity, or misclassified as non-accidental, we can fight for the benefits your loved one earned.
Submit Your Denied Claim for a Free Legal Review
If your AD&D claim was denied for any of the reasons above, we can help. Our life insurance lawyers have recovered millions from insurance companies that wrongfully denied coverage. Please complete our contact form with the details of your denied claim, or call 800-330-2274 for a free consultation.
FAQ: Denied Accidental Death and Dismemberment (AD&D) Claims
What is the most common reason for AD&D claim denials?
The most common reason is the insurer claiming the death was not truly accidental. They may argue it resulted from a medical condition, intoxication, or excluded activity.
Are drug and alcohol-related deaths automatically excluded?
Not always. The policy must explicitly exclude these circumstances, and the insurer must prove that intoxication directly caused the death.
Can a claim be denied if the insured had a pre-existing condition?
Yes, if the death is attributed to that condition instead of an external accident. However, these denials are often challenged if the accident was the true cause.
Do all high-risk hobbies void AD&D coverage?
Only if specifically excluded in the policy. Skydiving, scuba diving, and flying small aircraft are commonly listed, but exclusions vary by policy.
Is death during a crime always excluded?
Most policies exclude deaths that occur while committing or attempting a crime. However, the insurer must provide evidence that the insured was involved in the crime at the time of death.
What if the death was ruled accidental by the coroner but still denied?
Insurers may dispute the coroner’s ruling, but a legal team can use that ruling as evidence to support your claim and challenge the insurer’s conclusion.
Are self-harm or autoerotic activities covered under AD&D?
Generally no. These are often excluded as intentional or risky behaviors. However, legal arguments can sometimes succeed in proving the death was accidental.
Does reckless driving disqualify AD&D claims?
It can, depending on how the policy defines reckless behavior. Exceeding the speed limit may be argued as foreseeable or intentional, but not always.
Can you appeal a denied AD&D claim?
Yes. You have the right to appeal and submit evidence to challenge the denial. Legal representation is often crucial for success.
Do you offer free consultations for denied claims?
Yes. We provide free reviews of denied life insurance and AD&D claims. If we take your case, you pay nothing unless we recover for you.