What is a claim for Accidental Death and Dismemberment Benefits?

Accidental Death and Dismemberment (AD&D) is an insurance policy that pays benefits if the cause of death is an accident. In the event of an accidental death, this insurance will pay benefits in addition to any life insurance but only up to a set amount, regardless of any other insurance held by the client. This is called double indemnity coverage and is often available even when accidental death insurance is merely an add-on to a regular life insurance plan. Some of the covered accidents under AD&D include traffic accidents, exposure, homicide, falls, heavy equipment accidents and drowning. Accidental deaths are the fifth leading cause of death in the US as well as in Canada.


Fractional amounts of the policy will be paid out if the covered employee loses a bodily appendage or sight because of an accident. Additionally, AD&D generally pays benefits for the loss of limbs, fingers, toes, sight and permanent paralysis. The types of injuries covered and the amount paid vary by insurer and package, and the terms and conditions are explicitly laid out in the insurance policy.

Prevalent Exclusions

Insurance companies tend to keep a list of events, factors or circumstances that would void the insured’s entitlement to his or her claim. Death by illness, suicide, non-commercial radiation, war injury, and natural causes are generally not covered by AD&D. Similarly, death while under the influence of any non-prescribed drugs or alcohol is most likely exempt from coverage. Overdose with toxic or poisonous substances and injury of an athlete during a professional sporting event may void the right to claim too. Some insurance carriers will tailor their clients’ coverage to include some of the above risks, but every such extension will be accompanied by increased premiums.

Due to these restrictions, the process of claiming the benefit may be relatively lengthy. The deceased client may have to undergo autopsy and the accident may have to be officially investigated before a claim is approved by the insurer.

In other cases, companies may deny the claim because of any of the following reasons:

  • Denying the claim because the accident didn’t “directly cause” the death or dismemberment or because the death or dismemberment occurred too long after the accident
  • Denying the claim because of unpaid premiums
  • In the case of employer provided AD&D insurance, denying the claim because the employee hadn’t met the requirements for coverage (e.g., not employed for long enough or not working enough hours)

Types of Coverage

There are mainly four types of AD&D plans available in the United States as listed below:

  • Group Life Supplement – The AD&D benefit is included as part of a group life insurance contract and the benefit amount is usually the same as that of the group life benefit.
  • Voluntary – The AD&D is offered to members of a group as a separate, elective benefit, and premiums are generally paid as a payroll deduction.
  • Travel Accident (Business Trip) – The AD&D benefit is provided through an employee benefit plan and provides supplemental accident protection to workers while they are traveling on company business (the entire premium is usually paid by the employer).
  • Dependents – Some group AD&D plans also provide coverage for dependents.

Guest Post Author Bio:

Rome, Arata & Baxley L.L.C is a highly qualified and dedicated Houston Truck Accident Law firm that represents clients regarding truck accident issues.