Accidental Death and Dismemberment (AD&D) insurance is designed to provide financial protection when the unthinkable happens—offering a payout if the insured suffers a fatal accident or severe injury like the loss of a limb, sight, or hearing. But what many people don’t realize is that AD&D policies contain strict exclusions and complex definitions of what qualifies as an accident. As a result, valid claims are often denied—and insurance companies routinely use technicalities to avoid paying.
If your AD&D claim has been denied, don’t assume the insurer is right. Our life insurance lawyers have helped many clients overturn denied claims by challenging ambiguous policy language, confronting overly broad exclusions, and forcing insurers to honor their obligations.
Common Reasons Why AD&D Claims Are Denied
AD&D policies provide limited, specific coverage. This makes it easier for insurers to invoke exclusions, including:
Suicide or Self-Inflicted Harm: Claims are generally excluded if the death or injury was the result of intentional self-harm—even if the insured’s intent is unclear.
Drug or Alcohol Use: If toxicology reports show the insured had alcohol or drugs in their system, insurers often deny the claim, even if intoxication wasn’t the direct cause of death.
Dangerous Activities or Extreme Sports: Many policies exclude injuries or deaths from high-risk activities like skydiving, scuba diving, or off-road racing.
War and Terrorism: Deaths linked to acts of war, active military duty, or terrorism are frequently excluded.
Pre-Existing Conditions: If the insurer can argue that a medical condition contributed to the death, the claim may be denied—even if the death appeared accidental.
Natural Causes or Illness: AD&D does not cover deaths from heart attacks, strokes, or illnesses—even if the incident occurred during a physically demanding event.
Criminal Acts or Felonies: If the insured was engaged in illegal activity at the time of death or injury, the claim may be denied under a criminal activity exclusion.
Insurers often stretch these exclusions to deny claims that should be paid. For example, if a person dies in a car accident while under the legal alcohol limit, the company might still argue intoxication contributed to the accident. These denials can be challenged, especially if the exclusion is vague or not clearly proven.
What Does an AD&D Policy Actually Cover?
Despite their limitations, AD&D policies can provide meaningful benefits when a legitimate claim is approved. These include:
Death Benefits: If the insured dies in an accident that falls within the policy’s definition of covered accidental death, the designated beneficiaries receive a lump-sum payment. This can help ease financial burdens such as funeral costs, lost income, or outstanding debts.
Dismemberment or Functional Loss Benefits: If the insured survives but suffers serious physical loss—such as losing a limb, sight, speech, or hearing—the policy pays a benefit based on the severity of the injury.
Supplemental Benefits: Some policies offer additional perks, like coverage for emergency transportation, lodging for family members, or even rehabilitation support.
Low Cost and Accessibility: AD&D insurance tends to be more affordable than comprehensive life insurance and is often available without a medical exam, making it an appealing option for individuals with health concerns or tight budgets.
However, the simplicity of the application process can be misleading. Once a claim is filed, insurers often shift the burden of proof onto beneficiaries to demonstrate that the death or injury qualifies under narrow policy definitions.
How Our Life Insurance Lawyers Help with Denied AD&D Claims
When a claim is denied, we immediately request the full policy, the denial letter, medical records, toxicology reports, accident reports, and any internal insurer notes. Our legal team identifies weak spots in the insurer’s reasoning and prepares a strong appeal—or files suit if necessary. We’ve successfully handled claims where:
The insured was accused of drug use, but toxicology results were inconclusive
A fall-related death was denied as illness-related
An insurer claimed the death was not "accidental" due to pre-existing conditions
A motor vehicle accident was denied under the “criminal act” exclusion without basis
Our goal is always to get the full policy payout to the rightful beneficiaries as quickly and efficiently as possible.
Frequently Asked Questions
What is the difference between life insurance and AD&D insurance?
Life insurance pays for death from most causes, including illness. AD&D only covers deaths or injuries caused directly by accidents and excludes natural causes or pre-existing medical conditions.
Why was my AD&D claim denied if my loved one died in an accident?
Insurers may argue the death wasn’t accidental under the policy’s definition or apply exclusions related to drugs, illness, or criminal activity. These denials often require legal review to be challenged.
Does AD&D cover death from a car accident?
Yes—if the death was purely accidental and not due to excluded factors like intoxication, criminal activity, or medical events like seizures or heart attacks.
Are drug or alcohol exclusions always enforceable?
Not always. If the insurer cannot prove that the drugs or alcohol directly caused or contributed to the death, the exclusion may not apply. We often contest these types of denials.
Can I still recover a payout if the insurer says my loved one’s activity was too dangerous?
Potentially. We review the policy language and facts of the incident. Many "dangerous activity" exclusions are vaguely written or improperly applied.