Accidental death and dismemberment policies (ADD) cover accidental deaths, but not all beneficiaries receive their death benefit. An ADD insurance contract outlines certain situations around the death that can invalidate it resulting in a denial of death benefits.
Not all beneficiaries are aware of these clauses and their role when the insurer decides whether to pay an accidental death insurance claim. In this article, our life insurance attorneys explain how ADD insurance exclusions are applied and how to deal with claim denials based on them.
If you are the beneficiary of an ADD life insurance policy and suspect that the insurer uses an exclusion to wrongfully deny your claim, you should immediately seek legal advice. Call us at (888) 510-2212 to for a free consultation with one of our accidental death claims attorneys.
Life Insurance Exclusion Definition
A life insurance exclusion is a circumstance that prevents policy beneficiaries from collecting the death benefit. It is a clause in the policy that outlines which deaths are excluded from coverage.
Insurance companies include exclusions in their policies to protect themselves from risk. These exclusions help protect their financial interest by giving them the right to refuse payment for certain deaths.
What Are the Typical Exclusions that Apply to Accidental Death Life Insurance Policies?
Exclusions are controlled at the state level, but insurance companies have the right to decide what they list in their ADD policies. Here are the most common life insurance exclusions that you should be aware of when filing a life insurance claim:
Suicide
Most accidental death and dismemberment policies include a suicide exclusion clause which states that the beneficiares are not eligibile for death benefits should the insured take their own life. Self-inflicted harm may be made part of this exclusion.
Our ADD attorneys explain more about this life insurance exclusion in our article about life insurance payout and the suicide clause.
Illegal or Criminal Activity
Death while participating in illegal or criminal activity is a standard life insurance exclusion that most companies will list in their ADD policies. There will be no payment if the insured dies while participating in a crime/illegal activity (robbing a bank, stealing a car or as the result of an accident while they were driving under the influence of illegal drugs or alcohol).
Risky Activity
Death due to dangerous activities is another example of exclusions in life insurance contracts. Many accidental death and dismemberment policies outline very clearly the type of activities that are not covered. Here are the most common ones:
- Scuba diving
- Bungee jumping
- Flying a private plane (aviation)
- Hang gliding
- Skydiving
- Race Car driving
- Rock climbing
If the insured died while engaged in any of these activities, the life insurance company might not pay out.
Sickness or Treatment of a Sickness
Many accidental death policies exclude from coverage deaths caused by an illness or medical treatment of an illness. Such exclusions are usually very broad and may even include taking certain prescription medications. Read this blog post to learn more about the sickness life insurance exclusion.
Here is a case involving an ADD claim denied due to sickness exclusion after the beneficiary died in a motorcycle accident.
Substance Abuse
Another scenario in which most ADD life insurance policies exclude coverage is when the death occurs due to alcohol or drug abuse. We explain more on this life insurance exclusion in our article about life insurance payout and drug overdose.
Read about a few cases involving ADD claims denied due to substance abuse life insurance exclusions that our lawyers have solved:
- Denied claim due to drug exclusion;
- Denied ADD claim based on marijuana use;
- Claim denied due to intoxication life insurance exclusion.
Acts of War or Terrorism
Some insurance companies include a death-by-war exclusion clause in their accidental death policies. This means that beneficiaries will not receive the life insurance payout if the death occured during a war or was a result of a terrorist attack, domestically or abroad.
Things change if the insured was an active servicemember and had military life insurance instead of a private policy. Read our article on SGLI insurance to learn more about how such a policy works and what it covers.
Misrepresentation
When the policyowner dies within two years from the policy effective date, also known as the contestability period, the insurer has the right to contest the life insurance contract. This means that they review the life insurance application form. If they find significant inaccuracies compared to their medical records, referred to as “material misrepresentations”, they will invalidate the policy and deny paying the life insurance claim.
Our lawyers dive deeper into what this life insurance exclusion entails in our article about material misrepresentation on a life insurance policy.
Coronavirus
ADD insurance policies only cover accidental deaths. Coronavirus is considered the result of natural causes instead of accidents so an ADD policy may not provide coverage should the insured die of COVID-19. Their beneficiaries’ claim will be paid if they had a standard life insurance policy.
Read more about life insurance payout and coronavirus.
When Will ADD Insurance Policies Pay Out?
Accidental death policy exclusions vary. The language of the contract exclusion and the laws controlling such contracts are important in analyzing whether an accidental death claim will be paid. Unless certain life insurance exclusions apply, accidental death insurance policies should pay for accidental deaths caused by:
- Accidental drug overdose
- Drowning
- Car accidents
- Poisoning
- Choking
- Mixed prescription drug toxicity
- Falling
- Being struck by a vehicle
- Bicycle accidents
- Motorcycle accidents
- Accidental gunshot wounds
- Electrocution
- Alcohol poisoning
In such situations, if the ADD policy is effective at the time of death, the insurance company will pay out the proceeds. Read our blog post about dealing with lapsed life insurance policies if you are the beneficiary of such a policy.
What to Do if Your Death Benefit Claim Is Wrongfully Denied Based on a Life Insurance Policy Exclusion
Life insurance companies should apply exclusions in good faith. While most exclusions are applied properly, very often insurance companies use them as reasons to deny life insurance claims unfairly.
If you received a denial letter for any of the exclusions listed above, do not take it at face value. You might still have a chance at receiving the death benefit if you seek immediate help from an accidental death life insurance lawyer.
At our law firm, we have years of experience handling denied ADD claims for all of these life insurance exclusions. We can help you understand your life insurance beneficiary rights and offer competent advice on dealing with the case. Our attorneys can support you during the whole claim process from submitting a claim to appealing the claim denial or filing a lawsuit.
Here are a few cases where they helped clients recover the accidental death benefits they were wrongfully denied:
- ADD payout denied because the insurer claimed the death was not an accident;
- Claim denied although the insured drowned.
If you have issues with a denied life insurance claim, we can help. We work on a contingent fee basis which means that we get paid only if we win your case. Call us at (888) 510-2212 for a free case evaluation with one of our attorneys.
