AD&D denials we see often
- Vehicle and motorcycle crashes where the insurer blames alcohol or drugs.
- Falls, including falls at home or down stairs, where the insurer points to an underlying condition or intoxication.
- Drownings and environmental exposure, such as heat, where the cause of death is debated.
- Overdoses, where the policy has a drug exclusion and the question is whether the drug was lawfully prescribed or taken in the correct dosage.
- Accidental firearm discharges that were ruled suicide or undetermined.
- Homicides, and deaths during alleged criminal activity, where the insurer delays for a police investigation or invokes a crime exclusion.
- Undetermined deaths, where the medical examiner could not say whether the death was an accident, natural, suicide or homicide.
Why the evidence matters so much
AD&D disputes usually come down to facts: what happened, in what order, and why. Toxicology results can be misread, an autopsy can be cited for more than it says, and a crash report can leave out the road, the weather or the other driver. Our team includes medical and scientific consultants and former insurance company insiders who review this evidence alongside our lawyers.
Group AD&D through work
A lot of AD&D coverage comes through an employer. These plans often require a written internal appeal before any lawsuit, with a firm deadline. The appeal is usually the only chance to put medical opinions and other evidence into the record, so it should be built carefully, not filed as a short letter.
Talk to a lawyer before you respond
If an AD&D claim has been denied, or the insurer is asking questions about alcohol, drugs or medical history, talk to us before sending a statement. A free review costs nothing.
Questions families ask
If the death certificate says the manner of death was an accident, is that enough?
No. The death must also meet the policy's own definition of an accident, and many policies define the word narrowly enough that benefits are not payable. Even when a death is accidental, every policy has a list of exclusions that void coverage. For example, most insurers refuse to pay AD&D benefits when the insured was intoxicated and died in a car crash, even if the medical examiner ruled the death an accident.
The insurer says the insured was intoxicated. Is that the end of it?
Not necessarily. The wording of the exclusion matters, and so does whether the evidence shows that alcohol or drugs actually caused the accident. A blood alcohol number alone does not always answer that.
The medical examiner ruled the death undetermined. Can I still recover?
Sometimes. An undetermined ruling means the examiner could not decide, not that the death wasn't an accident. Other evidence can show what most likely happened.
Does a pre-existing condition defeat an AD&D claim?
Insurers often argue that an illness, such as heart disease, contributed to the accident. Whether that defeats the claim depends on the policy language and on medical evidence about what actually caused the death.
General information from the attorneys at Life Claim, not legal advice. Policies, plans and state laws differ, and every claim turns on its own facts.
