Understanding The Possible Exclusions In Your AD&D Policy

November 3, 2020 | J. Price McNamara
Understanding The Possible Exclusions In Your AD&D Policy

Planning to make sure that your family will have the financial support they need if you are injured or killed can be emotionally challenging, but it is an important part of planning for the future. Many people choose a mix of insurance coverages to help provide assurance that any possible unforeseen tragedy will result in an outcome that leaves your family financially solvent. While life insurance covers many of the most common causes of death, many people turn to an Accidental Death and Dismemberment (AD&D) policy to cover less likely — but often more devastating — possibilities. Unfortunately, those who find themselves facing the need to use an AD&D policy may — in the midst of a very difficult time in their lives — find even more barriers before them. Insurance companies often try to find exclusions to avoid having to pay out an AD&D policy.

What does an AD&D policy typically cover?

Accidental death is the third leading cause of death in the United States and the top cause of death for those ages 25 to 44. As one might expect, accidental deaths are also the most unpredictable, which means that families facing the aftermath of a death by accident are less likely to have prepared in advance for the outcome. Medical bills, funeral expenses, and the loss of dependable income can wreak havoc on the stability of a household. The protection of an AD&D policy is designed to provide some cushion against these financial burdens and pitfalls. An AD&D policy does not cover deaths from natural causes. Instead, they cover deaths of an accidental nature. These accidents could occur at work, at home, or while traveling. In addition, the "dismemberment" part of the policy provides a partial payout in the instance that an accident results in the loss of a limb or in paralysis. In the event of accidental death, the beneficiaries named on the AD&D policy will typically receive a lump sum payout. In the event of dismemberment, the insured will typically receive what's called a "living benefit." There are layers of details with an AD&D policy that can change the outcome. For example, for an accidental death that occurs on public transportation — such as an airplane, train, or bus — the benefits may be increased significantly. In addition, the partial payout in the event of dismemberment will likely be calculated based on the severity of the accident and its long-term impacts. For an accidental death to qualify under the AD&D policy, it does not have to be immediate. However, most policies do require that the death occur within a certain time frame — typically a few months — from the date of the accident.

What is not covered by AD&D policies?

The first thing to understand about AD&D policies is that they only cover accidental deaths. A death from illness or natural causes does not qualify for an AD&D payout. Typically, life insurance is used to cover these incidents instead. Injuries sustained prior to the start of coverage are typically not covered by AD&D policies. Other deaths and injuries that are typically not covered include those sustained through self-inflicted harm or suicide, during the act of committing a crime, while participating in an extreme sport such as skydiving or car racing, during the course of participation in a riot or war, while serving in the armed forces, or while under the influence of alcohol or drugs.

Why would an AD&D claim be denied?

Insurance companies will look into the details of any claim made under the policy and try to find any exclusions to the policy in order to deny the claim. The most common reasons to deny a claim include the following:
  • The death was not an accident but was instead from "natural" causes such as sickness, illness, or disease.
  • The death was caused by intoxication including the claimant's involvement in a drunk driving accident or some other accident while under the influence of drugs or alcohol.
  • The death was caused by drug overdose. This could include the consumption of an illegal substance or the use of a prescribed medication in a way that is "other than as prescribed by a physician."
  • The death was caused by self-inflicted injury or suicide.
  • The claimant failed to disclose information on the insurance application or falsified information that was included.

What should I do if an AD&D claim is denied?

The time after an accidental death can be confusing, grief-stricken, and challenging. Having an AD&D policy claim denied can make things even more complicated and difficult. Turning to a qualified, experienced attorney who can help you navigate the details of the claim and its denial is the best next step to help you gain control and understanding as you explore your options for moving forward. Contact us today for a Free Denial Review.
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J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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