Accidental Death Claim Denials: What to Do if Your AD&D Claim for Benefits Was 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 can be delayed or denied. This happens because insurance companies routinely apply numerous exclusions regarding accidental deaths.

In this blog post, our lawyers explain everything you need to know about accidental death claim denials, from what they cover to reasons for AD&D claim 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 attorneys have the experience you need to win your case. Call (888) 510-2212 for a free consultation.

Reasons for Accidental Death Claim Denials

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

A life insurance company could have a valid, legal reason for denying an accidental death or dismemberment claim. However, some insurance companies act in bad faith by denying life insurance accidental claims the company knows to be valid.

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The reasons an insurance company denies an AD&D claim include:

  • 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 that 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 resulting when the insured is voluntarily using a controlled substance unless it was prescribed by a doctor and it was used as prescribed.
  • 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?

Insurance companies often have strict rules for what is considered an accidental death. There are at least three main conditions to be met for a life insurance company to pay an accidental death claim:

  • Death must be ruled an accident, as defined in the policy and the law, and independent of any other causes. For example, if the insured suffered a heart attack, 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 but not accidental death policies. 
  • Death does not fall under an exclusion. An insurer’s statement that the death was excluded from coverage due to the application of a policy exclusion is one of the most common reasons life insurance will not pay out.
  • 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 accidental deaths that occur within 365 days after the accident. Otherwise, the insurer will argue that the accident did not cause 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.

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.

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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 the claim was filed, 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 Do You Need to Do if Your Accidental Death Claim Was 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 attorney to review your case.

We work with medical experts and forensic toxicologists 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. If your accidental death claim has been denied for any reason, we are here to help. We will work with you through this complicated process so you do not have to face insurance companies alone.

No Fee Unless We Win Your Case

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.

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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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