The Fine Print That Turns an Accident Into a Sickness

Sep 28

An accidental death policy can deny a claim even when everyone agrees the death was an accident — if illness or medication "contributed to" the outcome. That single phrase, buried in most AD&D policies, is the reason accidental death claims are denied far more often than standard life insurance claims. A federal appeals court applied it again in May 2026, and the decision is worth understanding before you file an appeal.

What happened in Beard v. Lincoln National

Edward Beard had stage IV pancreatic cancer. On December 16, 2022, he fell while hurrying to the bathroom. A CT scan that day showed nothing abnormal. The next morning he was unresponsive. A second scan found a large subdural hematoma — bleeding that had compressed his brain. He died shortly afterward.

Nobody disputed that the fall was an accident.

But Mr. Beard was taking blood thinners, prescribed to prevent clots related to his cancer. Lincoln National denied the AD&D claim, relying on a plan exclusion that barred benefits for "any loss that is contributed to or caused by... disease, bodily or mental illness (or medical or surgical treatment thereof)."

The insurer's position: the blood thinner made the bleeding worse, so the death was not caused solely by the accident.

The Eighth Circuit affirmed the denial. The court reached the same result through two separate provisions. It held that Beard had not established coverage in the first place because the policy required the fatal injury to result from the accident independently of all other causes. It then separately held that Lincoln had carried its burden of establishing the illness/treatment exclusion.

Beard v. Lincoln National Life Insurance Co., No. 25-2950 (8th Cir. May 11, 2026).

Why this decision matters to almost every AD&D claim

Two pieces of policy language did the work here, and they appear in most AD&D policies sold in the United States.

"Solely" and "independent of all other causes." Many AD&D policies pay only when an accident is the sole cause of death. Read strictly, that language is nearly impossible to satisfy for anyone who was not in perfect health. Most people who die in accidents are not in perfect health.

"Contributed to." This is broader than "caused by," and the difference is enormous. A cause has to produce the result. A contribution only has to help. Under the interpretation Lincoln applied — which Mrs. Beard conceded was reasonable and the court reviewed deferentially — medication that made the fatal hematoma worse could constitute a contribution even though the medication did not cause the fall.

Put together, those provisions allow an insurer to look beyond the immediate accident and ask whether an illness, medical condition, or its treatment actually contributed to the death. But the mere existence of a diagnosis is not enough. In Beard, Lincoln had medical opinions specifically connecting Beard's anticoagulant use to the severity and lethality of the subdural hematoma. The Eighth Circuit expressly declined to decide whether Beard's other medical conditions would have triggered the exclusion.

The part that decided this case, and that most families never hear about

Beard was an ERISA claim — the coverage came through an employer.

That is a substantially more deferential standard than ordinary contract review. A court may uphold the insurer's interpretation even if the court would have interpreted the policy differently on its own, so long as the insurer's interpretation is reasonable and its decision is supported by substantial evidence.

That is a dramatically lower bar. The insurer can be wrong and still win, as long as its reading was defensible. And "substantial evidence" means the record the insurer built during the claim and appeal — not evidence a family wishes it had submitted later.

This is why we tell families the same thing repeatedly: in an ERISA claim, the administrative appeal is the case. This is why the administrative appeal can effectively become the case in ERISA litigation. Courts generally review the administrator's decision based on the administrative record, subject to limited exceptions. Beard illustrates the danger: the Eighth Circuit specifically noted that Mrs. Beard had not submitted contrary medical evidence while her claim was before Lincoln. A favorable medical opinion obtained only after the administrative process has ended may come too late to help.

Where broad exclusions can still be beaten

Beard is a loss, and honest analysis says so. But it is not a rule that illness always defeats an AD&D claim. The arguments that do work:

The exact wording controls. "Caused by" is a much higher bar than "contributed to." Some policies exclude only losses caused "directly and independently" by illness. Many use no sickness exclusion at all. Read the policy, not the denial letter's characterization of it.

Contribution has to be real, not theoretical. A condition that existed but played no role in the death is not a contribution. Insurers routinely point at a diagnosis in the medical records and treat its mere presence as sufficient. That is a different argument from proving it mattered, and it frequently fails.

Ambiguity and state-law rules requiring exclusions to be construed narrowly can provide important arguments for coverage. In an ERISA case with discretionary review, however, those principles may operate differently because the court may be required to defer to a reasonable plan interpretation.

The burden is on the insurer. The claimant bears the burden of establishing that the loss falls within the policy's coverage. But once the insurer relies on an exclusion, the insurer bears the burden of establishing that the exclusion applies. Denial letters often blur this, writing as though the family must disprove any possible contribution.

The medical record can be contested. Insurers rely on file-review physicians who never examined the insured. A treating physician's opinion, or an independent expert's, is often the difference — but only if it is in the record before the appeal closes.

Individual policies are not subject to ERISA's deferential standard. If the coverage was purchased individually rather than through work, ERISA's deferential standard usually does not apply, and a court decides the coverage question itself. That changes the calculus significantly.

What to do if an AD&D claim was denied under a sickness or "contributed to" exclusion

Get the actual policy language — not the denial letter's summary of it. The difference between "caused by" and "contributed to" can decide the claim.
Determine whether ERISA applies. Employer-provided coverage almost always means ERISA, a short appeal deadline, and a record-based review.
Calendar the appeal deadline immediately. It is usually 60 to 180 days from the denial letter.
Build the medical record now. Treating physician opinions, independent medical review, and expert testimony about causation belong in the administrative appeal, not in litigation.
Do not concede contribution. Whether a condition actually contributed is a factual question the insurer must establish.
Have the denial reviewed before you respond. What goes into the appeal is frequently all a court will ever see.