Our life insurance attorneys recently recovered a $300,000 payout on behalf of a client whose Accidental Death & Dismemberment (AD&D) claim was denied. The insurer initially refused to pay, citing a policy exclusion and suggesting the cause of death was not covered. However, after a thorough review of the contract and a challenge to the insurer’s interpretation, we secured the full benefit owed to the beneficiary. This case highlights just how important it is to challenge claim denials—especially when exclusions are misapplied or misrepresented.
Why Life Insurance and AD&D Claims Are Denied: Understanding Policy Exclusions
When a life insurance company denies a death benefit, it often points to a policy exclusion. Exclusions are specific conditions or causes of death that allow the insurer to deny payment, even if the policyholder paid all premiums and met all obligations.
While life insurance exclusions are less common than they once were, they still appear in policies—especially in supplemental AD&D coverage, which pays out in the event of accidental death or serious injury. Some policies also contain outdated or obscure exclusions that insurers attempt to revive to avoid payouts.
Common exclusions include:
Death by suicide (typically within the first two years of coverage)
Material misrepresentation during the application process
Deaths resulting from felonious acts or participation in illegal activity
Deaths occurring during military service or acts of war (more common in older or group policies)
Non-accidental causes of death in AD&D policies
In the case we recently resolved, the insurer claimed that the death was not truly accidental and attempted to invoke an exclusion based on the circumstances surrounding the incident. After carefully analyzing the forensic reports, police records, and policy language, our attorneys demonstrated that the death clearly qualified as accidental under the terms of the contract.
The First Two Years: A Dangerous Window for Claim Denials
Insurance companies are much more likely to scrutinize claims filed within the first two years of a policy’s start date. This period, known as the contestability window, gives insurers the right to investigate the insured’s application for misrepresentations, omissions, or fraud.
While contestability clauses are designed to protect insurers from bad-faith applicants, some carriers exploit this provision to deny legitimate claims—even those involving minor or irrelevant errors on the application. This tactic is especially common when the policy has a lower death benefit, making it harder for grieving families to afford a legal fight.
In our experience, life insurance companies frequently deny claims during this window not because they have solid legal grounds, but because they assume beneficiaries will walk away quietly. That’s why it’s so important to seek legal guidance early.
Suicide and Misrepresentation: The Two Most Common Exclusions
Most modern life insurance policies limit their exclusions to two primary causes:
1. Suicide Exclusion:
Nearly all life insurance contracts contain a suicide exclusion, typically valid for the first two years of the policy. If the insured dies by suicide during this time, the insurer may only be obligated to return the paid premiums—not the full death benefit. After two years, the exclusion no longer applies.
2. Material Misrepresentation:
A policy may be rescinded if the insurer can prove that the insured provided false or incomplete information on the application that was material to the underwriting decision. Examples include failing to disclose a serious health condition, risky behaviors like drug use, or an undisclosed criminal history. However, not all misstatements qualify as “material.” The insurer must prove that the misrepresentation directly influenced their decision to issue the policy or determine its cost.
The Role of the Incontestability Clause
Most states require life insurance policies to contain an incontestability clause, which limits the insurer’s ability to challenge the validity of the policy after it has been in force for more than two years. After this period, the policy becomes “incontestable,” and the insurer can no longer deny a claim due to misrepresentation—unless it can prove outright fraud, which is a significantly higher burden of proof.
In the case of our client, the insurer’s denial was issued shortly before the two-year mark. However, our legal team uncovered evidence that the company had known about the alleged issue months earlier and delayed its investigation. We argued that the delay constituted a waiver of their right to contest, and ultimately forced a reversal of the denial.
Why Legal Representation Matters After a Denied Life Insurance or AD&D Claim
Insurers often rely on complex policy language, ambiguous exclusions, and procedural technicalities to deny claims. Without legal support, beneficiaries may accept the denial, not realizing they have the right to challenge the insurer’s findings.
Our attorneys have decades of experience handling denied life insurance and AD&D claims. We understand how to interpret policy language, gather supporting documentation, and confront insurers with facts and legal precedent. In many cases, the presence of an attorney is enough to prompt the insurer to offer a fair settlement rather than risk litigation.
What to Do If Your Claim Was Denied
1. Collect All Documents
Gather the policy, application, claim forms, denial letter, and any communication with the insurer. These materials are the foundation of your case.
2. Request a Detailed Denial Explanation
You have the right to understand why your claim was denied. Ask for a complete, written explanation that references the specific policy language used to justify the denial.
3. Contact a Life Insurance Lawyer Immediately
Do not respond to the insurer without legal guidance. One wrong statement could hurt your case. An attorney will evaluate the legitimacy of the denial and take over all communication.
4. Act Quickly
There are time limits to dispute a denied claim, so do not delay. The sooner you involve a lawyer, the more likely it is that you can preserve evidence and prevent the insurer from running out the clock.
We Can Help You Recover the Benefits You Deserve
If your life insurance or accidental death claim has been denied, don't give up. Insurance companies count on people walking away. We’re here to help you fight back—and win. Our legal team has recovered millions for beneficiaries nationwide, including a recent $300,000 AD&D payout wrongfully denied by the insurer.
Call us today for a free consultation. We’ll review your denial, explain your rights, and outline a plan to recover what you’re owed.