What Is an Accidental Death Benefit: Definition and Examples of When a Death Is Considered an Accident for Insurance Purposes

Accidental death coverage is offered to provide a payment in case an insured person dies as a result of an accident. The subject of what is considered an “accident” in the life insurance field is often subject to great disputes as policy contracts and laws in different states provide varying definitions of the word “accident.” Some insurance companies do not define the word “accident” in their policies, leaving insureds and beneficiaries confused about several possible interpretations. In this article, our attorneys will explain how to approach this subject to successfully collect an accidental death claim.

What Is an Accidental Death Benefit?

As we mentioned above, an accidental death policy offers protection when the insured dies due to an accident. Accidental death benefits may be found as a rider in a standard life insurance policy or as a separate contract. As a rider, accidental death coverage appears as an addendum to the initial life insurance contract.

Accidental death benefits can be part of an individual or a group policy sponsored by the employer. If accidental death coverage is offered by an employer, the policy is likely to be governed by ERISA. Otherwise, accidental death claims will be controlled by state law.

What Is Considered Accidental Death for Insurance Purposes?

Accidental death insurance only covers deaths resulting from an accident. For the insurance company to pay the benefits, the death or injury must result from an accident covered by the policy, independent of other causes. Here are a few examples of what is considered accidental death for insurance purposes:

  • A car accident or any other vehicle accident, including those involving public transportation;
  • Fire-related deaths, including burns, asphyxiation, or falling objects in the fire;
  • Falls;
  • Drowning;
  • Poisoning;
  • Being a victim of murder is considered accidental death when being shot or stabbed by another person, whether intentionally or not;
  • Industrial accidents, explosions, mining accidents, equipment malfunctions, and other work-related accidents;
  • Air, train, or water transport accidents;
  • Pedestrian accidents, getting hit by a car or other vehicle;
  • Choking. 

Does Accidental Death Insurance Cover Natural Deaths?

Unlike standard life insurance contracts, accidental death insurance coverage does not cover deaths from natural causes or illnesses. Below are some of the most common questions our life insurance lawyers receive about accidental death insurance claims and natural death causes:

  • Is a stroke considered accidental death?
  • Is a heart attack considered accidental death?
  • Does accidental death insurance cover cancer?
  • Is pneumonia considered accidental death?
  • Is COVID-19 considered accidental death?
  • Is death due to medical malpractice considered an accident?

Because the deaths listed above are deemed “natural” and do not meet the definition of an “accident,” companies will not pay an accidental death benefit.

What Is the Difference Between AD&D and Life Insurance?

The main difference between life insurance and accidental death insurance is that regular life insurance policies will pay out upon the insured’s death regardless of the cause of death, while accidental death insurance only pays for deaths due to accidents. 

Accidental death insurance only covers deaths and injuries resulting from an accident, as defined in the policy and state law. Accidental death insurance contracts usually have many exclusions that may trigger a claim denial even if the death was accidental.

Do Regular Life Insurance Policies Cover Accidental Deaths?

Yes, life insurance policies cover accidental deaths and deaths due to natural causes regardless of whether the insured had an AD&D rider. An accidental death policy usually offers extra benefits when the insured dies in an accident, sometimes called double indemnity. If the insured had both a standard life insurance policy and an accidental death policy and died in an accident, the insurer is obligated to pay both claims as long as none of the life insurance exclusions apply.

What Can You Do If an Insurance Company Denies Your Accidental Death Claim?

Accidental death claim denials are very common and very complex. Appealing a denied accidental death claim involves not only legal interpretations of the policy provisions but also investigating the death itself and the circumstances leading to it. Further, there is a very challenging task of analyzing toxicology reports and forensics when the claim is denied due to a substance.

Disputing an application of a certain exclusion often requires expert opinions and extensive legal research. At our firm, we have successfully recovered many denied accidental death claims and know what it takes to challenge an insurer’s denial. Call us now at (888)510-2212 for a free evaluation of your accidental death claim.

About the author

About the author

Attorney Tatiana Kadetskaya has over 10 years of experience in life insurance law representing beneficiaries and policy owners. She is best known for successfully collecting denied and delayed claims and settling complex beneficiary disputes and interpleader lawsuits.

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