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Common exclusions found in an AD&D policy

On Behalf of | Jun 22, 2023 | accidental death and dismemberment (AD&D)

If you have health or life insurance, there is a good chance you have accidental death and dismemberment (AD&D) coverage as well. It is a common rider on both life insurance and health insurance policies. As the name implies, AD&D insurance is for the unintentional death or dismemberment of the insured. Dismemberment can include either the loss of a body part or a bodily function, such as a limb, eyes or the ability to speak.

Exceptions to AD&D coverage

Having this coverage can be comforting. But you might not realize that your insurer has several exclusions in which it will not pay an AD&D claim. While each insurer has its own policies, common exclusions barring an AD&D claim include:

  • Suicide, injuries sustained in a suicide attempt, or self-inflicted wounds.
  • Death caused by an accidental overdose of a toxic substance.
  • Death while under the influence of nonprescription drugs.
  • Death or dismemberment while participating in certain recreational activities.
  • Death or injury while playing professional sports.
  • Death or injury resulting from war.

Your policy might include all of these exclusions, or it could explicitly cover some of them. You should read your policy carefully to know what you are covered for.

Appealing a denied claim

In general, AD&D insurance covers a fairly narrow set of circumstances. But if those fatal or disabling events never happened, AD&D coverage would not exist. If the insurance company denied your claim because the circumstances were supposedly not covered, you have the right to appeal. Appealing can be complicated and confusing if you try it on your own. Fortunately, you do not have appeal the denial on your own. An insurance attorney can advise and represent you.