Accidental death and dismemberment insurance, commonly called AD&D, pays benefits only when death or serious injury is caused by a sudden, external accident. These policies are far more restrictive than standard life insurance and are one of the most frequently denied types of claims.
Many families assume that if a death was unexpected, the claim should be paid. In reality, insurers closely scrutinize the cause of death, the surrounding circumstances, and any potential exclusions before approving payment.
Understanding the most common denial reasons can help you determine whether the insurer is correct or whether the decision can be challenged.
How AD&D Policies Define an “Accident”
To qualify for payment, the death must be:
• Sudden
• Unintentional
• Caused by an external force
• The direct and primary cause of death
If the insurer believes a medical condition, substance use, or excluded activity played any role, it may deny the claim.
One common dispute arises during recreational activities like scuba diving or skydiving. If the insurer finds evidence of a heart issue or other medical event that occurred before impact, it may argue that the death was caused by illness rather than the accident itself. These cases often turn on autopsy findings and medical expert opinions.
Accidental Deaths That Are Commonly Covered
AD&D policies usually cover clear physical accidents when there is no evidence of an underlying medical cause.
Motor vehicle accidents
Car and truck collisions are among the most frequently approved claims when police reports and autopsy findings confirm traumatic injury as the cause of death.
Example: A delivery driver was killed by a distracted motorist. The death certificate listed blunt force trauma, and the insurer paid the claim without delay.
Fires and explosions
Deaths caused by burns, smoke inhalation, or falling debris are typically covered if the fire was accidental.
Example: A tenant died from smoke inhalation during an apartment fire. Despite a history of asthma, the insurer paid because the fire was the primary cause of death.
Drownings
Drownings are often covered when toxicology reports show no drugs or alcohol and there is no seizure or cardiac history.
Example: A camper drowned during a supervised swim. The claim was approved after toxicology confirmed no impairment.
Fatal falls
Slip and fall deaths may qualify when there is no evidence of stroke, fainting, or other medical events preceding the fall.
Example: A man slipped on a wet hotel stairwell and suffered a fatal head injury. Surveillance footage confirmed the fall, and the claim was paid after initial delay.
Industrial and workplace accidents
Chemical exposure, machinery failures, and explosions may qualify when the exposure was accidental and job related.
Most policies also require the death to occur within a defined period, often one year, after the accident. If complications arise later, insurers may argue the accident was no longer the primary cause.
Common Exclusions Used to Deny AD&D Claims
Insurers rely heavily on exclusions when denying accidental death claims.
Medical conditions
If a heart attack, seizure, stroke, or other illness occurred before the accident, the insurer may deny the claim even if the accident was fatal.
Alcohol or drug involvement
Any presence of alcohol or drugs can trigger denial, even at low levels.
Example: A construction worker fell from scaffolding and died. Toxicology showed mild alcohol. The insurer denied the claim, arguing impairment. The family later challenged the decision with witness testimony.
Criminal activity
Deaths occurring during illegal conduct are often excluded.
Example: A man trespassing on railroad property was struck by a train. The insurer denied the claim based on illegal activity, despite the death being unintentional.
Medical treatment or procedures
Deaths during surgery or medical care are usually excluded because they are not considered external accidents.
High-risk or excluded activities
Many policies exclude professional racing, extreme sports, military service, or other specifically listed activities. Even amateur participation can trigger disputes if the policy language is vague.
Intentional acts
Self harm is excluded, even when impulsive or linked to mental illness.
What to Do If Your AD&D Claim Is Denied
Start by reviewing the denial letter carefully. Identify the exact exclusion or definition the insurer relied on.
Next, obtain the full policy, not just the summary. Many exclusions apply only in narrow circumstances, and insurers sometimes stretch their meaning.
Gather supporting evidence, including:
• Police and accident reports
• Autopsy and toxicology results
• Medical records
• Witness statements
• Surveillance footage, if available
Many AD&D denials are successfully challenged when evidence shows that the accident, not an excluded condition, was the true cause of death.
Example: A man died during an amateur skydiving trip. The insurer denied the claim under a “dangerous activity” exclusion that was never defined in the policy. A court ruled the clause unenforceable, and the claim was paid in full.
Final Thoughts
Accidental death insurance claims are denied far more often than families expect. Insurers frequently rely on technical exclusions, vague policy language, or questionable medical interpretations to avoid payment.
A denial does not mean the insurer is right. If the death was sudden, external, and truly accidental, the claim may still be recoverable.
We handle denied accidental death and dismemberment claims nationwide and routinely challenge improper denials. If your AD&D claim was rejected, a careful review of the policy and the facts can make all the difference.