Accidental Death and Dismemberment (AD&D) insurance should pay out for an accident resulting in death or severe injury. However, many beneficiaries have their claims denied.
Our life insurance attorneys handle denied AD&D claims from many insurance companies such as: Mutual of Omaha; Lincoln Financial; Nationwide; Aflac; Metlife; and more.
One of the most common reasons for denied AD&D claims is the policy’s definition of “accident.” Insurance companies typically require that the death or dismemberment results directly and solely from an accidental injury, without the influence of other factors such as pre-existing medical conditions. For example, if a person has a fatal heart attack while driving, leading to an accident, the insurer might argue that the heart attack and not the accident was the primary cause of death, thus excluding the claim.
Exclusions listed in the policy are another frequent basis for denial. AD&D policies often contain a variety of exclusions, such as deaths or injuries resulting from suicide, drug or alcohol use, acts of war, or participation in high-risk activities like skydiving or racing. For example, if a policyholder dies while under the influence of alcohol, even if the death appears accidental, the claim may be denied because the intoxication violates the policy terms. Such exclusions underscore the importance of thoroughly reading and understanding the policy details at the time of purchase. Another reason for denial stems from disputes over coverage eligibility. Insurers might question whether the individual was covered under the policy at the time of the incident. This can happen if premiums were not paid on time, the policyholder’s employment status changed, or the policy itself lapsed.
If there is conflicting evidence about whether a death was accidental or intentional, the insurer may rule against the claim. Also, if an accident’s circumstances raise suspicion such as a lack of witnesses or unclear medical report the company may withhold the money until resolved. Our top AD&D life insurance lawyers from LifeInsuranceAttorney.com fight denied claims and win.