Common Life Insurance Exclusions: What Is Not Covered by Accidental Death Policies?

Accidental death and dismemberment (AD&D) policies provide financial protection when a loved one dies in an accident. However, these policies do not cover every type of death—far from it. Many beneficiaries only discover after filing a claim that AD&D policies contain numerous exclusions that insurers use to deny payment.

Some exclusions are legitimate. Others are misapplied or stretched beyond what the policy actually states, leaving grieving families without the benefits their loved one paid for. Understanding what AD&D policies exclude—and how insurers use these exclusions—is crucial for filing a strong claim and fighting wrongful denials.

In this guide, our life insurance attorneys explain the most common accidental death policy exclusions, what they mean, and what beneficiaries can do if their claim is denied unfairly. If you believe your AD&D claim was wrongfully denied, call (888) 510-2212 for a free consultation.

What Is a Life Insurance Exclusion?

A life insurance exclusion is a clause in the policy that states which deaths are not covered. Insurers include these exclusions to protect themselves from financial risk and to limit claims involving certain behaviors or circumstances.

Exclusions are especially common in accidental death policies, which only pay for deaths that meet the strict definition of an “accident.”

If a death falls within an exclusion, the insurer may refuse to pay the AD&D benefit—even if the insured had paid premiums for years. However, many exclusions are misapplied, vague, or interpreted incorrectly. Beneficiaries often have the right to challenge these decisions.

Common Exclusions in Accidental Death & Dismemberment (AD&D) Policies

AD&D exclusions vary by policy, but most insurers rely on a predictable set of reasons to deny claims. Below are the exclusions beneficiaries encounter most frequently.

1. Suicide or Self-Inflicted Injury

Almost all accidental death policies exclude:

• Suicide

• Attempted suicide

• Self-inflicted injuries

If the insured dies by suicide, AD&D benefits are not paid. However:

• Suicide does not automatically void a regular life insurance policy forever.

• Suicide exclusions often apply only during the first two years.

• Many insurers misclassify unclear deaths as suicide.

• Doctor-assisted deaths are not always treated as suicide.

A police report or medical examiner’s findings can refute a wrongful suicide denial.

2. Illegal or Criminal Activity

Insurers frequently deny AD&D claims if death occurs while the insured:

• Was committing a crime

• Was involved in illegal activity

• Was driving under the influence of alcohol or drugs

• Was fleeing from law enforcement

These denials often rely on broad policy language. But not every violation of the law triggers an exclusion, and insurers often misapply this clause. If the underlying activity did not contribute to the death, the exclusion may not apply.

3. Risky or Hazardous Activities

Accidental death policies often exclude deaths involving extreme sports or hazardous hobbies. Common exclusions include:

• Scuba diving

• Skydiving

• Bungee jumping

• Hang gliding

• Aviation (private or non-commercial flights)

• Rock climbing

• Race car driving

If the insured died while engaging in one of these activities, the AD&D insurer may deny coverage.

However:

• Only listed activities can be excluded.

• If the activity was not named in the policy, the insurer must pay.

• Some insurers try to classify unrelated activities as “risky.”

Beneficiaries can challenge exclusions that exceed what the contract actually states.

4. Sickness or Treatment of a Sickness

AD&D policies do not cover deaths caused by illness, disease, or medical treatment. These exclusions are often broad and can include:

• Heart attacks

• Strokes

• Seizures

• Surgical errors

• Complications from medical treatment

• Prescription medications

Many wrongful denials occur when a death involves both an accident and a medical condition.

Example:
If an insured suffers a medical emergency while driving but dies in a car crash, insurers may deny the claim as “sickness-related”—even when the crash, not the illness, caused the death.

These cases require legal review.

5. Substance Abuse or Intoxication

AD&D policies commonly exclude deaths involving:

• Alcohol intoxication

• Illegal drug use

• Misuse of prescription medications

But insurers often stretch this exclusion too far. For example:

• A small amount of alcohol in the system does not automatically void coverage.

• Some drug exclusions apply only to illegal substances, not prescribed medications.

• If alcohol/drugs did not cause the death, the exclusion may not apply.

We have overturned many denials involving intoxication exclusions.

6. Acts of War or Terrorism

Some AD&D policies exclude deaths resulting from:

• War

• Military conflict

• Terrorist attacks

This exclusion generally applies to civilian accidental death policies—not to military life insurance such as SGLI. If the insured was an active servicemember, the proper coverage may be completely different.

7. Material Misrepresentation (During Contestability Period)

If the insured dies within the first two years after purchasing a policy, the insurer can challenge the application. They may deny a claim if they find:

• Inaccurate medical history

• Undisclosed prescriptions

• Incorrect weight or smoking status

• Undisclosed DUIs or criminal charges

However, the misrepresentation must be material and usually must relate to the cause of death. Many insurers wrongfully deny claims during contestability by alleging minor or unrelated inaccuracies.

8. Death from Natural Causes (Including COVID-19)

AD&D policies cover accidental deaths only. They do not cover:

• Heart disease

• Cancer

• Stroke

• COVID-19

• Organ failure

• Any natural cause of death

If the insured died from illness—not an accident—the AD&D policy will not pay. Standard life insurance may still provide benefits.

When Will Accidental Death Policies Pay Out?

Despite exclusions, AD&D policies must pay benefits when the insured dies in a covered accident.

Valid accidental causes include:

• Car accidents

• Drowning

• Accidental overdose

• Poisoning

• Choking

• Falls

• Motorcycle accidents

• Pedestrian accidents

• Bicycle collisions

• Electrocution

• Accidental firearm discharge

If an accident—not illness, suicide, or excluded activity—caused the death, and the policy was active, the insurer must pay.

What to Do If Your AD&D Claim Is Denied Due to an Exclusion

Just because an insurer cites an exclusion does not mean the denial is valid. Many exclusions are misapplied or based on vague allegations.

If your denial letter references an exclusion:

1. Do NOT accept the denial as final

Insurers often interpret exclusions broadly to avoid paying claims.

2. Request all claim documents

You have the right to access:

• Claim file

• Application

• Medical records

• Police reports

• Toxicology results

• Internal notes used in the denial

3. Contact a life insurance attorney immediately

These cases are complex. A lawyer can:

• Analyze whether the exclusion was properly applied

• Identify insurer errors

• Challenge the insurer’s medical/legal reasoning

• File an appeal or lawsuit

• Recover the AD&D benefits owed

Our attorneys have recovered benefits in cases involving drowning, drug exclusions, alleged non-accidental deaths, and many other exclusion-based denials.

Get Help with a Wrongfully Denied Accidental Death Claim

If your AD&D claim was denied due to an exclusion, you may still have a strong chance of recovering the full death benefit. Our attorneys have successfully appealed and litigated thousands of exclusion-based denials.

We work on a contingency fee basis — you do not pay unless we win.

To speak with an accidental death life insurance lawyer, call (888) 510-2212 for a free case evaluation.