I just took in a new case involving the denial of an Accidental Death insurance claim.

Accidental Death policies are different from Life Insurance policies.  Life insurance policies pay out when the insured person dies, regardless of the cause of death.  Accidental Death policies pay out when the insured person dies from an accident.  However, one common exclusion in Accidental Death policies is for deaths caused by a medical condition.

Unfortunately, insurance companies often become confused by their own policies.  And, as you know, when an insurance company succeeds in confusing itself about what its policy says, it then refuses to pay the claim.

My job is to clear up the confusion.

The “medical condition” exclusion allows the insurance company to deny claims if the death is caused by a medical condition.  For instance, if someone dies from a heart attack, that is typically not covered under an Accidental Death policy.

But, what if the heart attack causes a car accident, or causes someone to fall down a flight of stairs, and then that accident causes the death?  That is covered under the Accidental Death policy.

It’s really quite simple.  Deaths caused by a medical condition are not covered.  Accidents caused by a medical condition are covered.  Accidental Death policies have been around for hundreds of years, and the insurance companies know the law concerning the application of this exclusion perfectly well.  But, be careful.  When it comes to paying out claims, insurance companies often forget these basic principles and become very confused about what their polices cover.

Let me clear up the confusion.


If there is one message I want to get across to policy holders, it is this:  A denial letter is not the end of the inquiry, it is just the beginning!  Do not be intimidated by a denial letter no matter how strong you think it is. 

Every insurance case I’ve ever won has one thing in common.  They all started with “NO.”

In most of my insurance cases, if I win, the insurance company must pay my attorney’s fees and costs; and if I lose, I’ll work for free.

Mark Nation