Accidental Death and Dismemberment policies commonly contain illness exclusions that insurers rely on when denying claims. These provisions often state that benefits will not be paid if a sickness, disease, or medical condition contributed to the death.
In one case handled by our firm, a $145,000 AFLAC AD&D claim was initially denied after the insurer concluded that illness contributed to the fatal event. After the denial was challenged, the claim was ultimately resolved.
Attorney Christian Lassen focuses exclusively on life insurance and accidental death disputes nationwide.
The Accident and Initial Claim
The insured died following a sudden incident that appeared to involve an accident. The beneficiary submitted a claim under an AD&D policy issued by AFLAC seeking payment of the accidental death benefit.
During its review, the insurer obtained medical records and the death certificate. Based on these materials, AFLAC determined that a medical condition may have played a role in the insured’s death.
The insurer denied the claim and refused to pay the $145,000 accidental death benefit.
AFLAC’s Illness Exclusion
Many AD&D policies contain exclusions stating that benefits will not be paid when death is caused directly or indirectly by illness or disease.
If an AD&D claim has been denied based on an illness exclusion, legal review may help determine whether the insurer’s decision can be challenged.