Accidental Death Insurance Payouts: What to Do if Your AD&D Claim for Benefits Is 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.

Meaning: What Is Accidental Death Insurance?

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 the Difference Between AD&D and Life Insurance?

The main difference between life insurance and accidental death insurance comes from the circumstances that trigger the policy’s benefit. Regular life insurance policies will pay out upon the insured’s death regardless of the cause of death. Accidental death and dismemberment insurance, however, does not cover any death.

It only covers deaths and injuries that occurred as a result of an accident, as defined in the policy and state law. Accidental death insurance contracts usually have many exclusions which 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 as well as deaths due to natural causes regardless of whether the insured had an AD&D rider or not. It is just that an accidental death policy usually offers extra benefits when the insured dies in an accident. If the insured had both a standard 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.

How Does an Accidental Death Insurance Claim 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. Although most insurance companies need to process and pay accidental death 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 Does Accidental Death Insurance Cover: Examples

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.

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;
  • 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.

Does Accidental Life Insurance Cover Natural Deaths?

Unlike standard life insurance contracts, accidental death insurance does not cover deaths from natural causes or illnesses.

Below are some of the most common questions our life insurance lawyers received 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?

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

Is COVID Considered an Accidental Death?

COVID-19-related deaths are not considered accidents but rather due to natural causes. Therefore, they are covered by standard life insurance contracts, but not by accidental death insurance policies.

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

what is covered by an accidental death and dismemberment

Types of Deaths or Injuries Not Covered by AD&D Insurance 

All accidental death policies include accidental death “life insurance exclusions”. An exclusion is a provision in a contract describing a situation when accidental death benefits will not be payable.

  • 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

However, even if the insured’s death falls into any of the above categories, in some circumstances, insurers might be wrong in denying the accidental death payout. That is why, if you received a denial letter, it is best to consult with a life insurance attorney to check whether the claim denial is valid.

Denied Accidental Death Claims: How Can Life Insurance Companies Refuse to Pay Out?

There are three conditions to be met for a life insurance company to pay an accidental death claim:

  • Death does not fall under an exclusion.  An insurer’s statement that the death was excluded from coverage due to application of a policy exclusion is one of the most common reasons life insurance will not pay out.
  • Death must be ruled an accident, a result of a condition covered by the policy, and independent of any other causes. For example, suppose the insured suffered a heart attack while skydiving, leading to a fatal accident. In that case, the life insurance company will deny paying the accidental death benefit because the death was due to a heart attack, a natural death cause covered by standard life insurance contracts. 
  • 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 accident did not contribute to the insured’s death, therefore the delay between the accident and the death will render the claim not payable.

Our life insurance lawyers have successfully handled denied accidental death claims for all the reasons and exclusions mentioned 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

How to Claim Accidental Death Insurance?

Claiming accidental death benefits can be quite easy and straightforward once you understand what to do and have all the necessary documentation upfront. This includes copies of medical records, an autopsy report, or the death certificate.

Read more about how to claim life insurance benefits after death.

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.

by Tatiana Kadetskaya

by Tatiana Kadetskaya

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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