$260,000 Life Insurance Claim Recovered After AD&D Denial: What Exclusions Often Stand in the Way
Our top life insurance dispute law firm is proud to announce the successful resolution of a $260,000 denied life insurance claim. In this case, the insurance company denied benefits under an Accidental Death and Dismemberment (AD&D) policy, citing multiple exclusions they claimed applied to the insured’s death. After a thorough legal review and presentation of supporting evidence, our attorneys proved that the exclusions were being improperly applied and obtained the full payout for the beneficiary.
This case illustrates a broader issue many families face: denials based on broad or misused AD&D exclusions. While these policies are meant to provide financial protection in the event of an accidental death, the fine print often allows insurers to withhold payment for a wide array of reasons. Understanding what is commonly excluded can help beneficiaries prepare and respond when a claim is unexpectedly rejected.
Accidents Commonly Excluded from AD&D Coverage
AD&D policies are designed to pay only in specific accidental scenarios, and insurers often invoke a range of exclusions to limit their liability. Here are some types of accidents that are frequently not covered:
Illness-Related Events: Deaths resulting from illness, disease, or medical conditions like heart attacks or strokes are not considered accidental.
Pre-Existing Conditions: If an underlying health issue contributed to the death or injury, the insurer may argue the loss was not purely accidental.
Suicide or Attempted Suicide: Any self-inflicted injury, regardless of mental health status, is usually excluded.
Illegal or Criminal Activity: If the insured died while committing a crime or fleeing law enforcement, benefits are typically denied.
Riot or Civil Unrest: Participation in protests or riots, even if unintentional, can disqualify a claim.
Professional Sports or Organized Competitions: Injuries during professional or high-stakes sporting events often fall under excluded activities.
Speed Contests or Races: Involvement in car or motorcycle races, even informal ones, can trigger an exclusion.
Substance Use: Deaths occurring while the insured was intoxicated or under the influence of drugs may be disqualified, even if the substance was legally prescribed.
Non-Commercial Aviation: If the insured was flying as a pilot or passenger in a private plane, the policy might exclude coverage.
Seatbelt Violations: Some policies exclude benefits if the insured was not wearing a seatbelt at the time of a car accident.
No Valid Driver's License: Operating a motor vehicle without a current license can lead to denied claims.
Military Combat or Hazardous Work: Policies may deny claims for deaths occurring during active military service or in high-risk jobs like mining or logging if not specifically covered.
Extreme or High-Risk Hobbies: Activities like skydiving, rock climbing, or bungee jumping may fall under prohibited hobbies if not covered by a rider.
Terrorist Attacks and Acts of War: Many AD&D policies exclude any death resulting from acts of war or terrorism.
Travel to Restricted Areas: If the accident occurred in a country the U.S. State Department deemed unsafe, benefits may be withheld.
Engagement in Prohibited Activities: Any activity explicitly listed as prohibited in the policy will likely disqualify a claim.
Fighting Back Against Unfair AD&D Claim Denials
Insurers often use these exclusions to justify denying legitimate claims. In reality, many denials are based on vague interpretations, questionable evidence, or unproven allegations. Our legal team routinely challenges these decisions and pushes insurers to follow the letter of the contract rather than their own narrow reading of events.
In the $260,000 case we resolved, the insurer argued the insured was under the influence of medication and participating in a high-risk activity. We demonstrated through witness testimony and medical expert review that the insured’s conduct did not meet the policy’s definition of exclusion. As a result, we compelled the insurer to pay out the full death benefit.
Legal Support Makes the Difference
If you are facing a denied AD&D life insurance claim, it’s essential to act quickly. Time limits apply, and the appeals process can be difficult without experienced legal representation. Our attorneys will:
Analyze the policy and exclusion language
Gather evidence to rebut insurer claims
Consult with medical and accident experts
Submit appeals and file lawsuits when necessary
Don’t let insurance companies take advantage of complicated policy language. We will fight to ensure your rights are upheld and the benefits your loved one paid for are honored.
AD&D Policy Exclusion FAQs
Can an AD&D claim be denied for a heart attack? Yes. A heart attack is considered a natural cause and not an accidental death, so AD&D policies do not cover it.
What if the insured was under the influence of medication? If the insurer claims impairment, they must prove it contributed to the cause of death. Legal challenge may be possible if the medication was prescribed or not directly responsible.
Are deaths during sports always excluded? Not always. It depends on the level of participation. Professional or competitive events are more likely to be excluded, but recreational sports might be covered.
Can an insurer deny a claim for not wearing a seatbelt? Some policies have this exclusion. However, the denial can be challenged if seatbelt use did not contribute significantly to the death.
Is travel-related death excluded in dangerous regions? It can be, depending on the policy's travel limitations. Denials based on this exclusion must match exact policy terms and official government designations.
How long do I have to appeal a denied AD&D claim? Insurers typically allow 30 to 90 days to appeal. Check the denial letter and consult an attorney promptly.
What if the insured had a high-risk job? Unless the job is specifically excluded, such as military combat or unlisted hazardous work, the policy may still apply. Review the occupation clause closely.
Can a denied claim be overturned? Yes. With legal help, many denied AD&D claims are reversed through appeals, negotiation, or litigation.
What is considered a high-risk hobby? Hobbies like skydiving, bungee jumping, or racing are often considered high-risk. Coverage may be denied unless the policy includes a specific rider.
Do I need a lawyer for a denied AD&D claim? It is highly recommended. Insurers often misapply exclusions, and a knowledgeable life insurance attorney can dramatically improve your chances of recovery.