An AD&D claim is a request for benefits under an accidental death and dismemberment insurance policy, which pays out if the insured dies or suffers certain types of injuries due to an accident.

An accident is typically a sudden, unforeseen event causing injury or death, such as a car crash. It can also refer to a serious injury such as loss of limb or eyesight. However, just because someone dies or suffers a serious injury in an accident doesn’t mean insurance companies will automatically pay. AD&D policies often exclude deaths or injuries if other causes contribute to the accident. For example, if someone dies in a car crash but has alcohol in his or her system, insurers will typically deny those claims even though the death certificate refers to the manner of death as accidental.

There are many reasons why insurers deny AD&D claims. However, most denials follow a common theme: the insurance company will argue that the accident is excluded from coverage due to some contributing cause that made the accident happen. For example, if a person driving a car has a heart attack that results in a car crash, the insurance company will say that an underlying medical condition caused or contributed to the loss, relieving them of the liability to pay the claim. What you should know is that the insurance company is not always right, and there are ways to fight these claims.

Typically, loss of a limb (hand, foot, arm, leg), eyesight, or hearing caused by an accident within a specified period (e.g., 90 days) qualifies. Exact coverage varies by policy.

Before you submit an AD&D claim on your own, we strongly encourage you to reach out to a lawyer, especially if you have concerns about the possibility of your claim being denied. If you do go it alone, be careful about what you say to the insurance company or what evidence you provide them, as they will use anything you say or give them against you to deny your claim. They will also tell you that you can expect to receive a check within a certain amount of time, before ever even reviewing your claim. They do this to lull into letting your guard down and disclosing harmful information.

Processing of an AD&D claim typically takes 60–90 days, depending on the insurance company and case complexity. However, delays may occur if additional investigation or documentation is needed, and some AD&D cases may take many months to be resolved.

Yes, denied AD&D claims can almost always be appealed. However, it is critical to understand that the time frame for appealing a denial decision is often very short (usually 60 - 180 days depending on the insurance company). It is also important to understand what is required to successfully appeal a denied claim. Legal assistance is often necessary to help you navigate the appeal process, which is designed to benefit insurance companies rather than beneficiaries.

No, almost all AD&D policies exclude suicide, self-inflicted injuries, or deaths/injuries from risky activities like extreme sports or illegal acts.

Death certificates provide the cause and manner of death, and typically those items are not in dispute. But, sometimes those determinations are questionable, and you or the insurance company may disagree. For example, accidental gunshot wounds are often ruled to be suicides. Complex cases like this require experienced lawyers who can assess the evidence and determine where a claim can successfully be challenged.

You absolutely need a lawyer to assist you with a denied AD&D claim. This is because denial letters from insurance companies are misleading in that they fail to explain the importance of filing a comprehensive appeal. Most denial letters state that if you disagree with the insurance company’s decision, you can file an appeal, but the letters do not explain that your failure to make an argument or provide evidence in the appeal prevents you from ever making that argument or presenting that evidence to a judge if you file a lawsuit. Claimants who are unaware of this fact frequently destroy any chances of winning their case in court by preparing and submitting a deficient appeal without the benefit of a lawyer who understands how to set you up to win your case in the event litigation is necessary.