Losing a loved one is devastating on its own. When a life insurance company compounds that loss by denying a claim, the emotional and financial harm can be overwhelming. One especially troubling category of denial involves allegations of “intentionally self-inflicted injury,” a term insurers sometimes stretch far beyond its intended meaning.
A clear example involved Bill, a 52-year-old cancer survivor who died in a violent car crash. His death was officially ruled accidental by both law enforcement and the coroner. Bill’s family submitted a claim under his MetLife accidental death and dismemberment policy, expecting the $250,000 benefit the policy promised. Instead, MetLife denied the claim, asserting that Bill’s death resulted from an intentionally self-inflicted injury.
When Insurers Imply Suicide Without Evidence
The denial blindsided Bill’s wife. Beyond withholding the financial protection her husband paid for, the insurer’s position implicitly accused him of suicide. This was deeply painful and directly contradicted the facts. Bill had survived cancer, was engaged in life, and was actively planning for his family’s future. There was no suicide note, no prior attempts, and no evidence of intent. Despite this, MetLife relied on its own internal interpretation rather than the official accident ruling.
In cases like this, insurers sometimes substitute speculation for proof. Rather than accepting objective findings, they attempt to fit the facts into a policy exclusion to avoid payment.
Why “Self-Inflicted Injury” Denials Happen
Accidental death and dismemberment coverage is especially prone to denial because these policies contain narrower definitions and more exclusions than standard life insurance. Insurers may argue that a death was intentional, related to sickness, or caused by a preexisting condition, even when none of those claims are supported by the evidence.
In Bill’s case, the insurer invoked the self-inflicted injury exclusion, a provision intended to bar benefits for suicide or deliberate harm. Instead, it was used to deny coverage for a car accident already ruled accidental.
These problems are often amplified when the policy is governed by ERISA, the federal law that applies to many employer-provided life and AD&D plans.
The Added Burden of ERISA-Governed Policies
ERISA creates a tilted playing field for beneficiaries. Under ERISA rules:
There is no jury trial
Punitive damages are unavailable
Courts often defer to the insurer’s decision if it is deemed “reasonable”
Review is usually limited to the administrative record created during the appeal
This means families must present all supporting evidence early, during the internal appeal, or risk losing the ability to rely on it later. Insurers know this and often deny claims expecting beneficiaries to give up rather than navigate a complex federal appeals process.
How Common Are These Disputes
Life insurance disputes are far from rare. Industry data shows that a significant portion of claims encounter delays, disputes, or outright denials. Accidental death claims are particularly vulnerable. Common denial themes include:
Disputes over accident versus suicide
Broad application of self-inflicted injury exclusions
Allegations of misrepresentation on the application
Claims of policy lapse
ERISA procedural defenses
For families unfamiliar with these tactics, a denial letter can feel final. In many cases, it is not.
Challenging a Self-Inflicted Injury Denial
Denials based on alleged self-inflicted injury can often be overturned. Successful challenges typically rely on:
Police and coroner reports classifying the death as accidental
Autopsy and toxicology findings
Medical and mental health records showing no suicidal intent
Witness statements and accident reconstruction
Careful analysis of how the policy defines “self-inflicted”
When insurers ignore objective evidence, courts frequently side with beneficiaries, even under ERISA standards.
Frequently Asked Questions
Can a life insurance company deny a claim after an accidental death
Yes, but only if a valid exclusion applies. If the death is truly accidental and exclusions do not clearly apply, the denial may be improper.
What does “self-inflicted injury” usually mean in AD&D policies
It generally refers to intentional harm or suicide. Accidents do not qualify simply because the insurer suspects intent.
Do official accident rulings matter
Yes. Police and coroner determinations carry significant weight. Insurers must present strong evidence to contradict them.
What if the policy is governed by ERISA
ERISA limits remedies and favors insurers procedurally, but denials can still be overturned with a strong administrative appeal.
Why are AD&D claims denied more often than standard life insurance claims
AD&D policies contain more exclusions and narrower definitions, giving insurers more opportunities to deny coverage.
Is legal help really necessary
In most self-inflicted injury denials, yes. These cases often hinge on technical policy language and procedural rules that require experienced handling.
Do Not Accept the Denial at Face Value
A denial based on alleged self-inflicted injury is not just about money. It can unfairly rewrite a loved one’s story and deny the protection they worked to provide. If a life insurance or AD&D claim is denied on this basis, it is critical to have the policy and evidence reviewed carefully. Many of these denials are overturned once the facts are properly presented and the insurer is held to the terms of its own contract.