Fighting AD&D Life Insurance Denials: Common Reasons and How to Win Your Case
Accidental Death and Dismemberment (AD&D) claims are often denied by life insurance companies, despite being a critical safety net for policyholders. Many insurance companies find ways to avoid paying out these claims by citing exclusions, limitations, or disputing the circumstances surrounding the injury. At our top-rated life insurance law firm, we specialize in fighting these denials and ensuring that the rightful beneficiaries receive the compensation they deserve. Below are common reasons AD&D claims are denied, along with examples of cases we’ve resolved:
Common Reasons for AD&D Claim Denials
Occupational Hazards and Non-Covered Risks
Life insurance policies often exclude coverage for injuries related to certain work conditions or hazards. For example, a claim for loss of hearing due to exposure to loud noise at work may be denied if the insurer classifies the injury as an occupational hazard. Some policies specifically exclude injuries caused by conditions that arise from a policyholder's occupation, even though the injury itself may be accidental.Pre-existing Medical Conditions
A common reason for AD&D claim denials is the existence of a pre-existing medical condition. For instance, a claim for paralysis due to a stroke may be denied because a stroke is considered a medical event rather than an accidental injury. Similarly, conditions like diabetes or glaucoma may lead to denials if the insurer determines that the loss of vision or hearing was not caused by an accident but by a medical condition.Self-Inflicted Injuries or Risky Activities
Many life insurance policies have exclusions for injuries caused by self-inflicted harm or activities considered high-risk. For example, a claim for loss of a hand due to a firework explosion might be denied if the insurer deems it a self-inflicted injury or the result of irresponsible behavior. Similarly, if the insured was involved in a high-risk activity like operating a motorcycle without a valid license, a claim could be denied based on exclusions related to dangerous activities.Exclusions for Animal or Natural Element-Related Injuries
Life insurance policies may exclude injuries caused by animal attacks or natural elements. A claim for loss of a foot due to a snake bite could be denied if the policy excludes coverage for animal-inflicted injuries. Similarly, frostbite resulting from exposure to extreme cold may not be covered under policies that exclude injuries caused by environmental factors or natural elements.Non-Accidental Injuries or Medical Conditions
In cases where the injury is deemed to be non-accidental or caused by a medical condition, insurers often deny AD&D claims. For instance, a claim for loss of sight due to a laser pointer may be denied if it is classified as an intentional or negligent act. Other examples include losses due to health conditions, like cataracts, which are considered part of the aging process rather than an accident.
Examples of Denied AD&D Claims
Below are some specific examples of cases in which AD&D claims have been denied:
Bear Attack – Hunter in Alaska: The insurance company denied a claim for loss of life due to a bear attack, arguing that the injury was related to a high-risk activity (hunting) and excluded under the policy.
Lion Attack – Zookeeper in California: A zookeeper killed in a lion attack had their claim denied because the insurer categorized the death as resulting from an occupation-related hazard, which was excluded from coverage.
Cougar Attack – Jogger in Colorado: The claim for loss of life due to a cougar attack was denied on the grounds that the injury was not accidental but due to risky outdoor activities, which some policies exclude.
Motorcycle Accident – Rider Without a License: A claim for loss of a limb due to a motorcycle accident was denied because the insured was riding without a valid license, which violated the policy’s terms for motor vehicle use.
Loss of Foot – Snake Bite in Arizona: The claim for loss of a foot due to a snake bite was denied because the insurer classified the injury as an animal attack, which was excluded by the policy.
Hearing Loss – Prolonged Exposure to Loud Music: A claim for hearing loss due to prolonged exposure to loud music was denied, as the insurer classified it as self-inflicted damage and excluded it from coverage.
Loss of Limb – Skiing Accident: A claim for loss of a limb from a skiing accident was denied based on exclusions for high-risk activities, which often include skiing or other extreme sports.
How We Help You Fight Denied AD&D Claims
Our experienced life insurance attorneys specialize in fighting denied AD&D claims. We help clients navigate the complex insurance policies and exclusions that often result in denials. If you are facing a denied AD&D claim, we will:
Review Policy Terms: We examine the language of your life insurance policy to determine whether the denial was justified or if the insurer misinterpreted the terms.
Investigate the Circumstances: We gather evidence and assess the facts surrounding the injury to challenge the insurer’s reasoning for denial. This may include gathering witness statements, medical records, and expert testimony.
Challenge Exclusions and Definitions: We help challenge specific exclusions or limitations that may have been applied to your claim, including those for high-risk activities, self-inflicted injuries, or animal attacks.
Negotiate with Insurers: We negotiate with the insurance company on your behalf to reach a fair settlement or resolution. If necessary, we will take legal action to ensure your claim is paid.
Insurance Companies We’ve Successfully Resolved AD&D Claims With
Our top life insurance lawyers have successfully resolved AD&D disputes with major insurers, including:
USAA Life
Nassau Life
Baltimore Life
Liberty Mutual Life
We are committed to fighting life insurance denials and securing the compensation our clients deserve.
FAQ Section
Can a life insurance claim be denied due to a high-risk activity?
Yes, many life insurance policies include exclusions for deaths resulting from high-risk activities, such as skydiving, skiing, or operating a motor vehicle without a valid license.What happens if my AD&D claim is denied for a self-inflicted injury?
If your claim is denied because the injury is deemed self-inflicted, you may need to provide evidence to demonstrate that the injury was truly accidental, not intentionally caused by the insured.How can I challenge a denied AD&D claim?
Our attorneys can help you challenge a denial by reviewing the policy, gathering supporting evidence, and negotiating with the insurance company. If necessary, we will take legal action to recover the benefits you are entitled to.Can a claim for an animal attack be denied?
Yes, if the life insurance policy contains exclusions for animal-inflicted injuries, the insurer may deny the claim. However, our attorneys can help challenge the denial if you believe the exclusion was wrongly applied.What types of injuries are typically covered under AD&D policies?
AD&D policies generally cover injuries caused by accidents, such as falls, car accidents, and unexpected trauma. However, injuries caused by medical conditions, occupational hazards, or high-risk activities may not be covered.