Most AD&D policies require that the death or injury be caused solely, directly, and independently of all other causes by an accidental bodily injury. This strict definition is often used by insurers to deny legitimate claims. For instance, if someone has an undiagnosed heart condition and dies in a car crash, the insurer may argue that the heart condition—not the crash—was the true cause of death. Even if the injury appears accidental to the family, the presence of a contributing medical issue may disqualify the claim under the policy’s fine print.
Policy exclusions also play a significant role in AD&D denials. These exclusions are clauses in the policy that list specific situations in which the insurer will not pay. Common exclusions include deaths involving drug or alcohol use, suicide (even if accidental), self-inflicted injuries, war, participation in felonies, and high-risk hobbies such as racing or skydiving. For example, if a policyholder dies while driving intoxicated, the insurer may argue that alcohol contributed to the accident and invoke the intoxication exclusion—even if the death itself was unintentional.
Another layer of complexity arises when insurers dispute coverage eligibility. An AD&D policy may be tied to an employer or offered as a rider to a traditional life insurance policy. If premiums weren’t paid on time, if the policyholder left their job, or if there was a lapse in coverage due to administrative error, the insurer might deny the claim altogether—arguing the individual wasn’t covered at the time of the incident.
Insurers also frequently scrutinize the circumstances surrounding the accident itself. If there is ambiguity about what happened, such as a lack of witnesses or a vague medical report, the company may claim it cannot confirm the incident qualifies as an accident. In cases where the death could be interpreted as suicide or self-inflicted, the burden often falls on the beneficiary to prove otherwise. This can delay payment for months or even years, especially in high-dollar policies.
Suspicion alone can stall or derail a claim. Insurers may withhold benefits while they “investigate” the death or injury—often using independent medical exams or private investigators. This delay tactic can pressure families into accepting low settlements or abandoning claims altogether. It’s why working with an experienced AD&D lawyer is so critical. Our legal team knows how to force insurers to honor their contracts, cut through stall tactics, and recover what’s rightfully owed.
Our law firm has fought and won numerous AD&D claim disputes across a range of circumstances. Whether the issue involves a denied dismemberment payout due to unclear medical documentation, or a wrongful death denial linked to a policy exclusion, we bring the resources and experience needed to turn denied claims into paid settlements. Don’t accept an insurer’s denial at face value—especially when it’s based on obscure policy language or technicalities. A skilled attorney can make the difference between receiving nothing and securing a full payout. If you need a beneficiary dispute attorney in Washington we are here for you.
FAQ: Denied AD&D Life Insurance Claims
What is considered an “accident” under AD&D policies?
Most policies define an accident as an unforeseen, external event that causes death or injury. However, insurers often require that the accident be the sole and direct cause, which they use to deny claims involving medical conditions.
Can a claim be denied if the deceased had a pre-existing condition?
Yes. If a medical condition contributed in any way to the death or injury, even if triggered by an accident, the insurer may argue the event wasn’t “purely accidental.”
Do AD&D policies cover deaths involving alcohol or drugs?
Usually not. Most policies exclude coverage if the insured was under the influence of alcohol or drugs—even if the death was not intentional.
What happens if the policyholder’s job status changed before the accident?
If the policy was through an employer, coverage may end with employment. Insurers may deny claims if they argue the person was no longer eligible under the policy.
Can an insurer deny a claim based on lack of witnesses?
Yes. If the circumstances of the death are unclear or undocumented, insurers may deny claims pending further investigation—or allege the death wasn’t accidental at all.
Are suicide or self-inflicted injuries covered under AD&D?
No. These are standard exclusions. Even accidental overdoses or unclear deaths may be labeled as self-inflicted to justify a denial.
What if the policyholder died doing a risky activity like racing or skydiving?
High-risk activities are often excluded. Insurers may refuse payment if the death occurred during one of these, even if the policyholder had no history of doing it regularly.
Can beneficiaries challenge denied AD&D claims?
Absolutely. Many denials are based on subjective interpretations of “accident” or exclusions. A qualified attorney can contest these denials and recover the benefit.
What should I do if an AD&D claim is denied?
Request a full explanation in writing and consult a life insurance lawyer immediately. Time limits apply, and appealing with the right legal strategy can make a major difference.
Why do insurers deny legitimate AD&D claims?
Insurers prioritize their profits and often use narrow policy definitions, vague exclusions, and procedural loopholes to avoid paying out. Legal pressure is often the only way to secure payment.