Accidental Death Claims Wrongfully Denied: Two Cases We Successfully Overturned
Case Study: Accidental Death Claims Wrongfully Denied
Accidental death and dismemberment (AD&D) claims are supposed to provide families with additional financial protection when the unthinkable happens. But insurance companies often try to avoid paying these claims by stretching exclusions far beyond what the policy actually says.
Today, we highlight two real case patterns where insurers attempted to deny legitimate accidental death claims — and how we successfully overturned both denials.
Case Study #1: Fall With Traumatic Injuries Wrongly Classified as “Sickness”
Overview
Our client’s husband fell at home and suffered severe traumatic injuries, including:
Multiple fractured ribs
Significant internal bleeding
Hemorrhagic shock
Respiratory distress
He was hospitalized and tragically passed away several days later.
When the family submitted an accidental death claim, the insurer denied it under the “sickness exclusion.” Their argument:
Because the insured had an underlying bleeding disorder (a medical condition that made it hard for him to clot properly), the insurer claimed his death was “contributed to by sickness,” and that “a healthy person would have survived the accident”.
This interpretation was legally and medically incorrect.
The Insurer’s Argument
The denial letter stated:
The insured had a known bleeding disorder
His internal bleeding was “exacerbated by illness”
Therefore, the sickness exclusion applied
The policy excluded losses “caused or contributed to by sickness or disease”
This approach attempted to convert a clear accidental injury into a medical-condition death.
What We Discovered
After obtaining the medical records, autopsy report, and full claim file, several key facts emerged:
The fall caused the traumatic injuries.
Rib fractures and blunt-force trauma are accidental injuries by definition.The bleeding disorder did not cause the fall.
There was no evidence of a medical event (syncope, stroke, heart issue) preceding the fall.The medical examiner listed the cause of death as the traumatic injuries.
The underlying bleeding disorder was incidental, a major contributing factor to the death.The policy required sickness to be the primary cause of death to invoke the exclusion.
The insurer ignored this.Case law in multiple jurisdictions rejects this exact insurer argument.
A pre-existing condition that is merely incidental does not exclude the accidental death from coverage.
Outcome
We submitted a detailed appeal with:
Medical analysis showing the fall initiated the fatal injuries
Legal precedents showing sickness exclusions cannot override an accidental cause
A breakdown of the policy’s “accidental means” and “efficient proximate cause” language
Within weeks, the insurer reversed its decision and paid the full AD&D benefit.
Case Study #2: Car Crash Wrongfully Denied for “Misdemeanor” / Reckless Driving
Overview
Our client’s daughter died in a tragic car accident while driving to work. According to the police report:
Her car veered off her lane
She crossed into the opposite lane
She collided with another vehicle
The insurer denied the accidental death claim because they claimed she was “committing a misdemeanor” — specifically, reckless driving — and the policy excluded accidents “caused or contributed to while committing a criminal act.”
This was a clear misapplication of the exclusion.
The Insurer’s Argument
The denial stated:
The insured operated her vehicle “recklessly”
Reckless driving can be classified as a misdemeanor
Therefore, the death was excluded from coverage
The insurer treated an unintentional traffic violation as a criminal act equivalent to DUI, reckless driving, or fleeing from police.
What We Discovered
After reviewing the policy, accident report, and legal definitions, we uncovered the following:
Reckless driving is not an intentional criminal act.
In most states, it is a civil infraction, not a crime.The insurer ignored the policy’s requirement for intentional conduct.
Exclusions for “misdemeanors” were meant for intentional wrongdoing — not momentary negligence.There was no evidence of drugs, alcohol, or reckless behavior.
Nothing suggested criminal conduct.There was a defect in the car that caused it to veer off the lane.
There was a serious defect in the car that caused the accident.
Insurers cannot deny claims based on hypothetical citations.
A person cannot be deemed committing a “misdemeanor” based on what they might have been ticketed for.Courts routinely reject insurer attempts to classify minor infractions as criminal exclusions.
Policies must be interpreted in favor of coverage.
Outcome
We prepared a legal appeal arguing:
Reckless driving did not cause the accident
Even if it were, the exclusion applies only to intentional criminal conduct
The policy language was ambiguous and must be construed in favor of coverage
The insurer eventually accepted our position and paid the full accidental death benefit.
The family finally received justice after a denial that should never have been issued.
Why These Accidental Death Cases Matter
These cases reveal a troubling pattern:
Insurers frequently misuse exclusions to avoid paying accidental death benefits.
Common wrongful denial reasons include:
Sickness exclusions
Illegal drug exclusions
Prescription drug exclusions
Alcohol exclusions
Criminal act or misdemeanor exclusions
Policy ambiguity exploitation
But the law and policy language often protect families more than insurers admit.
Frequently Asked Questions About Accidental Death Denials
Q: Can an insurer deny an accidental death claim because of a pre-existing condition?
Not if the accident independently caused the injuries. A condition that worsens the outcome does not eliminate coverage.
Q: Can minor traffic violations void an accidental death claim?
No. Most policies require intentional criminal acts, not ordinary negligence.
Q: What if the medical examiner lists multiple contributing factors?
As long as an accident initiated the chain of events, accidental death benefits usually apply.
Q: Do insurers often misinterpret exclusions?
Yes. Many denials are based on broad, unsupported interpretations of sickness, drug or criminal exclusions.
Q:Should I appeal an accidental death denial?
Absolutely. These denials are frequently overturned.
If Your Accidental Death Claim Was Denied, I Can Help
Accidental death denials are among the most heartbreaking — and the most reversible.
📞 Call 1-888-510-2212 for a Free Consultation
Email: info@life-insurance-lawyer.com
📘 Before You Go: Don’t Face a Denial Without a Plan
A denied life insurance claim can feel overwhelming — especially when you're grieving.
That’s why I created the Ultimate Checklist, a free downloadable guide that walks you step-by-step through:
✔ what to read
✔ what to request
✔ what deadlines matter
✔ what mistakes to avoid
✔ and when to call a lawyer
This guide was made to help you protect your rights before the insurance company locks you into an unfair outcome.
👉 Download your FREE Ultimate Checklist now
(You can print it, save it, or bring it to your free consultation.)
