Accidental Death Insurance: What to Do if Your Claim for Benefits Has Been Denied

Accidental death policies are designed to provide financial support to beneficiaries when the insured dies due to an accident. Unfortunately, as with many life insurance policies, accidental death claims are frequently delayed or denied. This happens because insurance companies routinely apply numerous exclusions that exclude accidental deaths from coverage. 

In this blog, our accidental death lawyers explain everything you need to know about accidental death claim denials: from what they cover to reasons for denials and how to appeal a denied claim. 

If you are the beneficiary of an accidental death policy and your claim has been denied, our accidental death lawyers have the experience you need to win your case. Call 888-510-2212 for a free consultation.

What Is Accidental Death Insurance?

An accidental death policy offers protection when the insured dies as a result of an accident. Accidental death benefits may be found as a rider in a regular 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 policy 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 Does Accidental Death Insurance Cover?

Accidental death insurance covers deaths resulting from an accident. For the insurance company to pay the benefits, the death or injury needs to be the result of an accident covered by the policy.

Accidental death insurance is different from regular life insurance policies in that it is triggered only when there is an accident. Unlike standard contracts, it does not cover deaths from natural causes or illnesses (such as heart attacks or strokes). 

accidental death insurance claim denied

Does Accidental Death Insurance Cover COVID-19?

While regular life insurance policies cover most causes of death (unless certain exclusions apply), accidental death contracts only pay for deaths due to accidents. COVID-19 related deaths are not considered accidents, but rather due to natural causes, so they are not covered by accidental death insurance policies.

If the insured purchased a life insurance policy with an accidental death rider, the life insurance company will pay the COVID-19 related claim but will deny the accidental death rider amount.

Our life insurance attorneys wrote more on this topic in our article about whether life insurance covers coronavirus-related deaths.

Do Regular Life Insurance Policies Cover Accidental Death?

Life insurance policies cover accidental death as well as death to natural causes. Accidental death policies usually offer extra benefits when the insured dies in an accident. If the insured had both a regular life insurance policy and an accidental death policy and died in an accident, the insurance company is obligated to pay both claims as long as none of the exclusions apply.

Accidental Death Insurance Claims: How Do They Work?

If the insured died in an accident, the beneficiary of an accidental death policy will file a claim with the insurance company. Usually, the claim should be submitted by a certain deadline. Our life insurance lawyers outlined the claim filing process in our article about how long you have to claim life insurance.

The insurance company will assign a claims examiner who will contact the beneficiary requesting documents proving that the death was accidental and not due to natural causes. A death certificate will generally classify the death as natural or accidental. 

However, insurance companies rarely rely on this classification alone. They will usually conduct an independent investigation into the cause of the death. Such records as police reports, toxicology reports, and coroner’s reports are examined and become part of the record. Once the documents are submitted and liability becomes clear, the insurance company must pay the claim promptly.

However, many accidental death claims are delayed for months and even years. The reason for the delay is usually an ongoing investigation. Even though most insurance companies need to pay claims within 30-60 days from the date of death, many insurers delay payment on the grounds that they do not have sufficient evidence proving that the death was due to an accident. Our life insurance attorneys explained this in more detail in our article about how long it should take to get a life insurance check.

what is covered by an accidental death and dismemberment

Reasons Why Insurance Companies Deny Accidental Death Benefits 

For the accidental death insurance policy to pay out, the death must be ruled an accident and independent of any other causes. For example, if the insured suffered a heart attack while skydiving which leads to a fatal accident, the life insurance company will deny paying the accidental death benefit because the death was due to a heart attack. 

At the same time, if the death is considered a result of an accident, beneficiaries will receive the policy payout only if it occurred within a certain time frame after the accident. Most policies will cover deaths that occur within 365 days after the accident. Otherwise, the insurer will argue that the delay between the accident and the death will render the claim not payable. 

Proving that the death was accidental is not the only hurdle. Another common reason life insurance will not pay out is the application of various accidental death exclusions. An exclusion is a provision in a contract describing a situation when accidental death benefits will not be payable. Almost all accidental death policies have such exclusions. Many accidental death policies typically exclude from coverage the following deaths:

  • Deaths due to self-inflicted injuries, suicide or attempted suicide, whether sane or insane;
  • Deaths caused by or contributed to by illnesses including mental illnesses;
  • Participating in a riot or an act of war, whether declared or undeclared;
  • Deaths sustained while in the armed forces of any country or international authority;
  • Deaths sustained while riding on any aircraft: a) as a pilot, crew member, or student pilot; b) as a flight instructor or examiner;
  • Deaths resulting from overdose while voluntarily taking drugs which federal law prohibits dispensing without a prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed physician;
  • Deaths sustained while committing or attempting to commit a felony;
  • Deaths sustained as a result of being legally intoxicated from the use of alcohol; 
  • Driving while under the influence; 
  • Deaths occurring during a medical procedure, surgery, or post-surgical recovery;
  • Deaths resulting from medical malpractice;
  • Deaths due to car racing, playing professional sports, or participating in risky recreational activities such as skydiving, scuba diving, or bungee jumping;
  • Deaths occurring as a result of autoerotic asphyxiation

Thus, even if the insured died in an accident, your accidental death claim may be denied if the insurance company claims that the death is excluded from coverage for any of these reasons.

Our life insurance lawyers have successfully handled denied accidental death claims for all of the reasons above. We will work relentlessly on protecting your beneficiary rights and recover the money you are entitled to. Call 888-510-2212 for a free case evaluation.

what is covered by an accidental death and dismemberment

Contact Our Life Insurance Lawyer if Your Accidental Death Claim Has Been Denied

To avoid a claim delay and a potential denial of your accidental death benefits, work with an experienced life insurance attorney from the start. 

Insurance companies draft their policies using complex language that can sometimes be ambiguous and may have two or even more possible meanings. You may read it to mean that the coverage should exist while the insurance company claims that the same language denies coverage. If that happens, you need an experienced accidental death attorney to review your case. Our life insurance attorneys are skilled at reading insurance contracts.

We work with medical experts who review a toxicology report, a coroner’s report, a medical examiner’s report, and a police report to determine whether you can appeal the claim denial. In many cases, medical experts’ opinions differ and the denial of benefits will be reviewed in court.

We also have the experience needed to litigate accidental death claim denials in state and federal courts. If your accidental death claim has been denied for any reason, we are here to help. We will work with you through this difficult process so you do not have to face insurance companies alone.

No Fee Unless We Win Your Case

Our life insurance law firm offers free consultations. We may ask you to provide us with copies of the documents that will help us evaluate your case. We work on a contingent fee basis and will zealously fight for your recovery. Call us at 888-510-2212 to request a free case evaluation with an accidental death lawyer.

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