Fidelity Life Accidental Death and Dismemberment Claim Denial Successfully Resolved
Our life insurance law firm is proud to announce the successful resolution of a denied Accidental Death and Dismemberment (AD&D) claim involving Fidelity Life. The insurer initially rejected the claim based on policy exclusions and disputed cause of death. After an in-depth investigation and strategic legal action, our attorneys were able to reverse the denial and secure the full payout for our client. This victory adds to our growing list of successful outcomes against major insurance providers, including Family Heritage Life, Chesapeake Life, Occidental Life, Liberty Mutual Life, Summit National Life, Western & Southern Life, Unison International Life, Zander Life, and more.
Why AD&D Claims Are Denied—and How We Fight Back
AD&D insurance is designed to offer financial protection in the event of sudden, accidental death or serious injury. Despite this seemingly clear coverage, insurance companies often find ways to deny claims—usually by citing exclusions, vague policy terms, or disputing whether the event qualifies as an “accident.” If you’ve had an AD&D claim denied, it’s likely the insurer relied on one or more of the following tactics.
1. Exclusions for Non-Accidental Causes of Death
Most AD&D policies clearly exclude coverage for deaths resulting from natural causes, illness, or self-inflicted harm. If an insurer determines that the insured died due to a medical condition—rather than a true accident—they may deny the claim outright. In many cases, the line between natural and accidental causes is blurred, and insurers take advantage of this ambiguity. Our attorneys frequently challenge these denials by securing independent autopsy reviews, medical expert opinions, and accident reconstructions.
2. Misrepresentation or Omitted Information
If the insured failed to disclose relevant details during the application process—such as pre-existing medical conditions, substance use, or participation in hazardous activities—the insurer may argue that the policy was issued under false pretenses. This breach of the duty of utmost good faith can result in rescinded coverage. However, insurers often overreach by labeling minor or irrelevant omissions as “material misrepresentations.” We push back by proving that the missing information was not central to the policy approval or the cause of death.
3. Intoxication and High-Risk Activity Exclusions
Many AD&D policies include clauses that exclude coverage for injuries or death sustained while under the influence of alcohol or drugs. Similarly, policies may void coverage for deaths occurring during professional sports, reckless behavior, or illegal activity. For example, if an insured dies in a car accident with alcohol in their system, the insurer may deny the claim based on intoxication exclusions—even if the alcohol level was under the legal limit. We scrutinize the toxicology reports and investigate whether the exclusion applies, often finding insufficient justification for the denial.
4. Disputed Definition of "Accident"
The term accident is often more restrictive than people realize. Most policies define an accident as an “unforeseen, sudden, and unintended” event. Insurers may deny claims if they determine the death resulted from a foreseeable or voluntary act—such as engaging in extreme sports or risky behavior. If the insured’s death could arguably have been anticipated, insurers may argue that it wasn’t truly accidental. Our legal team challenges these interpretations by highlighting real-world definitions, medical documentation, and policyholder intent.
5. Ambiguous Cause of Death or Injury
If there is conflicting evidence about how the insured died or sustained an injury, insurers may delay or deny the claim pending further investigation. This often happens in car accidents, drownings, or falls where toxicology results or witness statements are inconclusive. Insurers may try to shift blame to illness or argue that the insured contributed to their own death through negligence. We work with medical examiners and accident reconstruction experts to establish a clear timeline and cause of death that supports the claim.
6. Procedural Denials and Filing Errors
AD&D claims are often denied on technical grounds, such as:
Missing deadlines for filing a claim
Incomplete paperwork or lack of required documentation
Discrepancies in the insured’s identity or records
Failure to prove dismemberment qualifies under policy terms
These administrative reasons are frequently used as delay tactics. Our attorneys resolve these issues quickly, making sure claims are submitted properly and follow-up demands are met.
We Fight to Win Every AD&D Claim Denial
Whether your AD&D claim was denied due to policy exclusions, misrepresentation, cause-of-death ambiguity, or administrative reasons, we have the experience to challenge it. Our life insurance lawyers know how insurers operate—and how to hold them accountable.
We handle denied and delayed AD&D claims, as well as:
Life insurance claim denials
Beneficiary disputes
Interpleader lawsuits
FEGLI and SGLI federal insurance disputes
We offer free consultations and work on contingency—meaning you don’t pay us unless we recover benefits on your behalf.
FAQ: Denied Accidental Death and Dismemberment (AD&D) Claims
What does AD&D insurance cover?
AD&D covers death or specific serious injuries (like loss of limb, sight, or hearing) caused solely by accidental means. It does not cover illness, suicide, or natural causes.
Why was my AD&D claim denied?
Common reasons include exclusions for intoxication, criminal acts, or high-risk behavior, as well as disputes over whether the event was truly accidental.
Is death from drug or alcohol use covered?
Often not. Many policies exclude deaths where the insured was under the influence of alcohol or drugs. However, not all intoxication clauses are enforceable—especially in borderline cases.
Can an insurer deny a claim due to misrepresentation?
Yes—especially during the contestability period. But our firm often proves the alleged misrepresentation was either immaterial or misunderstood.
Can I still recover if the cause of death is disputed?
Yes. We gather medical records, autopsy results, and expert analysis to establish the true cause of death and prove it meets the policy definition of an accident.
What if the insurer says the claim form was incomplete or late?
That alone shouldn’t result in a denial. We help resolve paperwork issues and challenge denials based on minor procedural defects.
What’s the difference between AD&D and life insurance?
AD&D only pays if death or injury was accidental. Regular life insurance covers most causes of death, including illness and natural causes.
Do I need a lawyer to appeal an AD&D denial?
Absolutely. Insurers aggressively defend these claims. Our attorneys build strong legal appeals and are prepared to litigate when necessary.