Accidental Death and Dismemberment claims are frequently denied by insurers who argue that a fatal event was not truly accidental under the policy’s definition. In a recent case involving Mutual of Omaha, our firm secured a two million dollar payout after the insurer denied an AD&D claim by stretching policy language and relying on exclusions that did not apply to the facts. After a full factual investigation and targeted legal challenge, the denial was reversed and the family received the full benefit.
This case illustrates how aggressively insurers attempt to narrow the meaning of “accidental death” and how those denials can be defeated when evidence and policy language are properly analyzed.
How Mutual of Omaha Justified the Denial
The insured died following a sudden traumatic event that resulted in fatal injuries. Emergency responders, witness accounts, and medical findings all supported an accidental cause of death. Despite this, Mutual of Omaha denied the AD&D claim, asserting that the death fell outside the policy’s definition of an accident.
The insurer relied on broad exclusionary language and suggested that the event was either foreseeable, related to an underlying condition, or the result of conduct that removed it from coverage. The denial did not point to a specific exclusion clearly supported by the evidence. Instead, it relied on interpretation and implication rather than proof.
Why AD&D Insurers Focus on Semantics
Unlike traditional life insurance, AD&D policies pay only when death results directly from an accident. Insurers exploit this distinction by arguing over terminology rather than facts. The goal is to reframe a sudden injury as something else, such as a medical event, voluntary risk, or non covered activity.
In practice, this means insurers examine every detail of the insured’s health history, behavior, and surroundings. If they can suggest an alternative explanation, even without confirming evidence, they often issue a denial and wait to see whether the beneficiary challenges it.
Evidence That Undermined the Denial
In this case, we assembled a comprehensive factual record that included medical findings, scene documentation, and expert analysis. The evidence showed that the insured’s death resulted from external trauma and not from illness, intentional conduct, or excluded activity.
There was no medical proof of a precipitating health event. There was no evidence of intoxication or reckless behavior. There was no policy language clearly excluding the activity involved. The insurer’s theory required speculation rather than demonstrated causation.
Once the record was fully developed, the denial became difficult to justify under the policy’s own terms.
Common AD&D Denial Theories That Fail Under Scrutiny
This Mutual of Omaha case reflects patterns seen in many AD&D denials nationwide. Insurers frequently attempt to deny claims by arguing:
A medical condition must have caused the accident without medical confirmation
The activity was inherently dangerous even though not excluded
The insured assumed the risk by engaging in ordinary behavior
A prior injury or condition contributed to the event
The accident was foreseeable and therefore not accidental
Courts and regulators often reject these arguments when insurers cannot connect them directly to the cause of death.
Why Foreseeability Is Often Misused
One common tactic is arguing that an accident was foreseeable and therefore not accidental. This interpretation is flawed. Most accidents involve some level of foreseeable risk. That does not remove them from coverage unless the policy clearly excludes the activity.
In this case, Mutual of Omaha attempted to rely on a vague foreseeability argument without pointing to specific exclusionary language. When pressed to defend that interpretation, the position could not be sustained.
Policy Interpretation Worked Against the Insurer
AD&D policies are contracts, and ambiguous language is interpreted against the insurer. Exclusions must be clear, specific, and supported by evidence. Generalized language does not allow an insurer to deny coverage based on assumptions or hindsight analysis.
Once the policy language was applied to the actual facts, rather than hypothetical alternatives, Mutual of Omaha’s denial lacked contractual support.
How the Claim Was Ultimately Resolved
After submission of expert opinions, a detailed legal analysis, and direct challenges to the insurer’s reasoning, Mutual of Omaha reversed its denial. The full two million dollar AD&D benefit was paid to the beneficiary without the need for a trial.
The outcome was driven by documentation and pressure, not negotiation alone. Once the insurer was required to justify its interpretation under the policy, reversal became the only viable option.
Why Families Should Not Accept AD&D Denials at Face Value
Many beneficiaries assume that an AD&D denial means the policy simply does not apply. In reality, many denials are based on aggressive interpretations that do not withstand legal review. Insurers rely on the fact that most families will not challenge a technical denial during a time of grief.
This case demonstrates that even large AD&D denials can be overturned when the facts support accidental causation and the policy language is enforced as written.
Final Takeaway
Accidental Death and Dismemberment claims are denied far more often than they should be. Insurers frequently misuse exclusions, redefine accidents, and rely on speculation to avoid payment. When those denials are challenged with evidence, expert analysis, and focused legal arguments, they often collapse.
This two million dollar Mutual of Omaha AD&D case shows that accidental death claims can still be won, even after an initial denial, when insurers are held to the facts and the contract they wrote.