Accidental Death Claim Denials: What to Do if Your AD&D Claim for Benefits Was Denied

Accidental death and dismemberment (AD&D) insurance is supposed to provide financial protection when a loved one dies as the result of an accident. Families often rely on these benefits to cover funeral costs, replace lost income, and stabilize their financial future after an unexpected tragedy. Unfortunately, accidental death claims are among the most frequently delayed, disputed, or denied types of life insurance claims. Insurance companies routinely rely on policy exclusions, ambiguous definitions, and narrow interpretations of “accident” to avoid paying AD&D benefits.

If your accidental death claim was denied, you are not alone. Our life insurance lawyers regularly handle denied AD&D claims and help beneficiaries recover money that insurers refuse to pay. This guide explains why accidental death claims are denied, how AD&D exclusions work, what documentation insurers require, and—most importantly—what you can do to fight back after a denial.

If your AD&D claim was denied, call (888) 510-2212 for a free consultation today.

What Is an Accidental Death Benefit?

Accidental death benefits are paid when the insured dies directly, independently, and solely due to an accident. These benefits may be provided through:

• A standalone AD&D policy, or

• An accidental death rider attached to a standard life insurance policy

• Employer-sponsored group accidental death insurance, often governed by ERISA

To qualify for payment, the death must meet the policy’s definition of an “accident” and must not be caused or contributed to by illness, medical conditions, or excluded activities. Insurers carefully scrutinize every claim and often deny them—even when the death appears clearly accidental.

Reasons Accidental Death Claims Are Denied

All accidental death policies contain exclusions—contract provisions stating circumstances under which the insurer will not pay benefits. Some exclusions are legitimate, while others are misapplied or interpreted unfairly. Understanding these exclusions is key to knowing whether your denial is valid.

The most common reasons AD&D claims are denied include:

1. Self-Inflicted Injuries or Suicide

Accidental death insurance will not pay for deaths caused by:

• Suicide

• Suicide attempts

• Self-harm (even if the insured was mentally ill)

These exclusions apply whether the insured was “sane or insane” at the time.

2. Illness-Related Deaths

If illness contributes—even indirectly—to the death, insurers often deny AD&D claims. Examples include:

• Heart attack prior to a fall

• Stroke leading to a car crash

• Diabetic complications

• Mental health crises

Insurers typically argue the accident was “caused by illness,” not accidental.

3. Drug and Alcohol-Related Deaths

Claims are often denied if:

• The insured had illegal drugs in their system

• The insured misused prescription medications

• The insured was intoxicated while driving

• Toxicology reports reveal levels outside therapeutic ranges

Even small amounts of substances may trigger a denial.

4. Excluded Activities

Insurers often deny claims when the death occurred during:

• Car racing

• Professional sports

• Skydiving

• Scuba diving

• Bungee jumping

• High-risk recreational activities

These exclusions are often broad and heavily disputed.

5. Criminal Activity

AD&D benefits are typically denied if death occurred while:

• Committing a felony

• Fleeing law enforcement

• Participating in illegal activity

However, insurers sometimes apply this exclusion even when the link to criminal activity is weak or unproven.

6. Aviation Exclusions

Deaths occurring while the insured was:

• Piloting an aircraft

• Serving as crew

• Taking flying lessons

…are frequently excluded.

7. Medical or Surgical Complications

Accidental death policies almost never cover deaths involving:

• Complications from surgery

• Anesthesia reactions

• Medical malpractice

• Post-operative infections

Even unexpected complications are considered “natural causes,” not accidents.

8. Autoerotic Asphyxiation

Many AD&D policies explicitly exclude these deaths.

When Insurers Wrongfully Deny AD&D Claims

Even if a death appears to fall under one of the exclusions, insurers sometimes misinterpret or misapply the policy language. For example:

• The insured had trace amounts of alcohol, but not enough to impair driving

• A fall was caused by slipping, not by illness

• A medication was legally prescribed and taken as directed

• The insured was not committing a felony, despite the insurer’s allegations

• The insurer relied on incomplete or inaccurate police or medical reports

This is why it is critical to have a life insurance attorney review your denial letter. What insurers describe as a “valid exclusion” is often legally challengeable.

How Insurance Companies Evaluate Accidental Death Claims

When a beneficiary submits an accidental death claim, the insurer begins its own investigation, which may include:

1. Reviewing the Death Certificate

This typically states whether the death was:

• Natural

• Accidental

• Homicide

• Suicide

• Undetermined

However, insurers never rely on the death certificate alone.

2. Requesting Additional Documentation

Insurers seek:

• Police reports

• Toxicology reports

• Autopsy results

• Medical examiner records

• Medical history

• Witness statements

These records are analyzed to determine whether the death meets the definition of an accident.

3. Determining Contributing Causes

If any medical condition contributed to the death, insurers often deny AD&D benefits—even if the accident was the primary event.

4. Evaluating Time Limits

Most accidental death policies require that the insured must die within 365 days of the accident for benefits to be payable. If death occurs after this time, insurers argue the accident did not “directly” cause the death.

Because this process is complex and biased toward the insurer, many valid claims are denied.

How to Appeal a Denied Accidental Death Claim

If your AD&D claim was denied, do not accept the insurer’s decision without a legal review. Appealing a denial involves:

• Understanding the policy language

• Challenging incorrect interpretations

• Disputing the insurer’s medical conclusions

• Gathering new evidence

• Working with medical experts, forensic toxicologists, and accident reconstruction specialists

Our life insurance lawyers routinely overturn denials related to:

• Alcohol or drug allegations

• Illness-related exclusions

• Aviation exclusions

• High-risk activity exclusions

• Criminal activity allegations

We handle both state law accidental death claims and ERISA-governed claims for employer-sponsored coverage.

Why You Need an Experienced Life Insurance Attorney

Insurance companies use broad policy language and ambiguous definitions to support their claim denials. Without legal representation, beneficiaries often struggle to:

• Interpret policy exclusions

• Access necessary records

• Challenge toxicology interpretations

• Understand ERISA appeal requirements

• Navigate complex legal deadlines

Our attorneys handle every aspect of the appeal so you do not have to face the insurance company alone.

No Fee Unless We Win Your Case

We work on a contingency fee basis.
You pay nothing upfront, and no legal fees at all unless we recover the AD&D benefit for you.

If your accidental death claim has been denied, delayed, or unfairly investigated, call (888) 510-2212 for a free case evaluation. We have the experience you can trust to fight for your rights and recover the benefits you are owed.