Accidental Death and Dismemberment insurance pays benefits only when death results from an accident. Because of this limitation, insurers frequently attempt to reclassify accidental deaths as natural causes in order to deny AD&D claims.
This reclassification is one of the most common and aggressive denial tactics used after death.
Why the Accidental vs Natural Distinction Matters
AD&D policies typically exclude deaths caused by illness, disease, or natural bodily processes. If an insurer can characterize the death as natural rather than accidental, the claim can be denied even when an accident clearly occurred.
The dispute often centers on how the death is framed rather than what actually happened.
Common Reclassification Scenarios
Insurers frequently argue that:
• A heart attack caused a fall rather than the fall causing death
• A seizure caused a car crash rather than trauma causing death
• A stroke preceded a drowning rather than drowning being accidental
• A medical condition triggered an accident
• The body failed internally rather than due to external force
These arguments are often speculative and unsupported by conclusive evidence.
Medical Examiner Language Is Often Exploited
Medical examiners may list contributing conditions on a death certificate even when trauma was the primary cause of death. Insurers selectively rely on this language to claim the death was natural.
A contributing condition is not the same as the cause of death.
Policies Require Direct and Independent Causation
Many AD&D policies require that death result directly and independently from accidental injury. Insurers use this language to argue that any medical condition defeats coverage.
Courts often reject this approach when trauma is the dominant cause.
ERISA AD&D Claims Face Additional Obstacles
Employer provided AD&D policies governed by ERISA allow insurers to control the record and interpretation of evidence. Once a denial is issued, new evidence is often barred from court review.
This makes early intervention critical.
Reclassification Without Proof Is Improper
Insurers are not permitted to invent medical explanations to avoid paying claims. A denial must be supported by credible evidence, not assumptions or hindsight reasoning.
Unsupported reclassification may constitute bad faith.
Warning Signs of Improper Reclassification
Red flags include:
• Ignoring trauma listed as cause of death
• Relying on minor medical history
• Cherry picking autopsy language
• Rejecting treating physician opinions
• Citing internal medical reviewers only
These tactics are commonly challenged successfully.
How Beneficiaries Can Fight Reclassification Denials
Successful challenges often involve:
• Clarifying the chain of events
• Demonstrating trauma as the dominant cause
• Challenging speculative medical opinions
• Using treating physician statements
• Highlighting policy language requirements
Many reclassification denials do not survive scrutiny.
Accidental Death Reclassification Denials Are Often Reversed
We routinely recover benefits in AD&D cases where insurers attempted to reclassify accidental deaths as natural causes.
Our firm represents beneficiaries nationwide in denied AD&D and life insurance claims. There is no fee unless benefits are recovered.
If your AD&D claim was denied because the insurer reclassified an accidental death as natural, contact us for a free case evaluation.