Accidental death and dismemberment policies are designed to provide benefits when a fatal injury occurs because of an accident. However, insurers sometimes deny AD&D claims when the insured dies from aspiration after a fall. The insurer may argue that the death resulted from a medical condition or airway complication rather than the fall itself.
Aspiration deaths frequently occur when a person inhales stomach contents, blood, or other material into the lungs. When this occurs after a fall, insurers may try to separate the aspiration event from the accident that caused the injury.
Attorney Christian Lassen represents beneficiaries nationwide in disputes involving denied accidental death and dismemberment claims.
What Aspiration Means in Medical Terms
Aspiration occurs when foreign material enters the airway or lungs instead of the digestive tract. This can happen when a person loses consciousness, suffers trauma, or cannot properly protect their airway.
Aspiration can lead to several fatal complications including:
Airway obstruction
Aspiration pneumonia
Severe respiratory distress
Oxygen deprivation
In many cases involving falls, aspiration occurs after the person becomes unconscious or seriously injured.
How Aspiration Can Follow a Fall
A fall can create the conditions that lead to aspiration. The injury may affect breathing, consciousness, or the body’s ability to protect the airway.
Common scenarios include:
Loss of consciousness after head trauma
A fall may cause a head injury that leaves the person unconscious or unable to respond.
Example:
An individual falls, suffers a head injury, loses consciousness, and later aspirates stomach contents while lying on the ground.
Facial or airway injuries
Falls can produce facial trauma, bleeding, or swelling that interferes with breathing.
Example:
After a fall down stairs, the insured sustains facial injuries and aspirates blood that enters the airway.
Vomiting after trauma
Head injuries and internal trauma sometimes trigger vomiting, which increases the risk of aspiration.
Example:
Following a fall, the insured vomits while unconscious and aspirates stomach contents.
Immobilization after injury
A fall may leave the person unable to move or reposition themselves to protect the airway.
Example:
The insured falls in a bathroom and remains unconscious for an extended period, eventually aspirating.
Why Insurers Deny AD&D Claims in Aspiration Cases
Insurance companies often deny these claims by focusing on the aspiration event rather than the fall that caused the situation.
Denial letters may argue:
The death resulted from aspiration rather than accidental trauma
A medical condition caused the aspiration
The fall occurred because of illness rather than an external accident
The death was caused by airway obstruction, not by accidental injury
In some cases, insurers claim that a medical condition triggered the fall, which then led to aspiration.
Death Certificates Can Complicate These Claims
Death certificates often list aspiration as the immediate cause of death. This wording can create problems for beneficiaries because insurers frequently rely on that line when denying AD&D claims.
For example, a certificate may state:
Immediate cause of death: aspiration of gastric contents
Underlying cause: fall with head injury
Even when the fall caused the chain of events leading to aspiration, insurers may focus only on the immediate cause listed.
When the Cause of the Fall Is Disputed
Another common issue arises when the insurer questions why the fall occurred in the first place. If the insurer believes a medical condition caused the fall, it may argue that the event was not accidental.
Example:
The insurer claims the insured fainted or suffered a medical episode before falling.
These arguments often rely on medical records, toxicology reports, or speculation about the insured’s health before the fall.
Evidence That May Clarify What Happened
Aspiration related AD&D denials often depend on a detailed reconstruction of the events leading to the death.
Important evidence may include:
Emergency response reports
Hospital and emergency room records
Autopsy findings
Toxicology results
Witness statements describing the fall
The wording of the AD&D policy
These records can help determine whether the fall was the initiating event that led to the fatal aspiration.
Legal Help With AD&D Claim Denials
Aspiration related AD&D denials often involve disputes about the chain of events leading to death. Even when aspiration is listed as the immediate cause of death, the accident that caused the fall may still be central to the analysis.
The Lassen Law Firm focuses exclusively on life insurance and accidental death disputes nationwide. Attorney Christian Lassen has more than 25 years of experience representing beneficiaries in denied, delayed, and contested insurance claims.
If an AD&D claim was denied because the insurer says aspiration rather than the fall caused the death, legal review can help determine whether the denial can be challenged.