One of the most common questions I get from people about life insurance is what is considered accidental death for insurance purposes?
This question usually comes up if we are talking about an accidental death benefit rider, an accidental death & dismemberment policy (AD&D) or an accident policy – all of which might pay out a death benefit but only if the death was due to an accident.
After discussing how those options work, it’s only natural then for people to wonder what is accidental death and what is not.
And, if someone you know recently died, you might also wonder if they died of an accidental cause or not. Many people wondering the exact same thing have taken the time to post a question in the comments below.
The answer isn’t always easy to figure out.
So, I have a lot to cover but let’s start by going over what an accidental death is and what it means.
What is an Accidental Death?
The definition of an accidental death is a death that is caused by an unintentional injury. Any death caused by an intentional, self inflicted injury or by a natural cause like old age, a disease or illness would not be considered an accidental death.
To get a clearer picture of what an accidental death is, let’s start by going through some common accidental death examples. After that, I’ll go over some examples that are not considered accidental death.
Accidental Death Examples
Accidental death examples are in the news every day.
From people being shot and killed to fatal traffic accidents, many different types of accidental deaths caused by unintentional injuries occur each and every day.
To get an idea of what qualifies as an accidental death, a key to whether a death is accidental or not is if it was caused by some unintentional injury.
Let’s take a look at some examples of deaths caused by unintentional injuries.
Here are the three leading causes of accidental death, according to the CDC.
- Poisoning The leading cause of accidental death was an unintentional poisoning. People are accidentally poisoned in a variety of ways from ingesting or inhaling toxic substances by mistake or an accidental overdose caused by unknowingly taking too much prescription medication.
- Auto accidents The second leading cause of accidental death was motor vehicle accidents. It’s sad but I get alerts on my phone nearly every day of fatal auto accidents near where I live.
- Falls While it’s the third leading cause of death overall, if you are over 65 years old, it’s the leading cause of accidental death.
Other examples of accidental death:
- Murder (or Homicide) Being shot, stabbed or murdered by some other person is an accidental death. A murder is considered an accidental death even if the person who killed you did it intentionally. There are also all kinds of crazy stories of people who killed other people for the life insurance too.
- Suffocation Examples of suffocation would be getting choked on food, obviously someone else choking you or somehow cutting off your on supply of oxygen. I’ve heard of children getting tangled in the chords from blinds and I even once read a story about a child choking on an automatic window of a car.
- Drowning Unfortunately, every year I read sad stories of people dying in swimming accidents on reservoirs or of children dying in pools.
- Fire or burns Another example of accidental death is by fire or burn. The most common example that comes to mind is from a house fire.
- Pedestrian deaths Getting hit by a car or some other vehicle is another example of an accidental death. With the number of people texting while driving these days and getting into accidents, it would seem like pedestrians are at a higher risk of getting struck by a vehicle than ever before.
- Adverse effects to medication I suppose this would be similar to poisoning above but the CDC listed it separately. A death by an adverse reaction could happen even if you took the prescribed dose.
- Other land transportation Listed by the CDC are accidental deaths by other land transportation. My guess is that this would be anything in a moving vehicle not on an actual road. The first thing that comes to my mind are accidental deaths cause by those ATV’s or four wheelers that people ride.
- Other unspecified accidents This would the so called freak accidents that probably don’t occur very often. Getting struck and killed by an icicle, work related accidents or other types of accidental death that occur so infrequently that it doesn’t merit its own category but was still unintentional.
Accidental deaths are the third leading cause of death overall but are the number one cause of death for people between the ages of 1-44 years of age.
These are just a few examples of the types of accidental deaths.
Next, let’s talk about what is not an accidental death, but is instead a natural death or a death due to natural causes.
Natural causes: Is a heart attack, stroke, cancer or dying from other illnesses considered an accidental death?
Dying a natural death, or of natural causes, is not considered an accidental death. A natural death is one where you die of old age or of an illness.
Here are three of the most common questions people ask about natural deaths:
- Is a heart attack considered an accidental death?
- Is a stroke considered and accidental death?
- Is cancer considered an accidental death?
In all three of these cases, none of these would be considered an accidental death.
This would include dying from old age as well.
Some underlying medical condition or disease is usually the cause.
Now that you know what an accidental death is, why does it matter?
Why how you died matters: Because accidental death insurance benefits (or accidental life insurance) may pay out
After someone dies, funeral arrangements must be made. Funerals cost money and that’s when your loved ones look for what kind of life insurance you had in place.
In many cases, it’s discovered that the only life insurance in place was accidental death insurance. This poses a big problem for families whose loved one died of natural causes. That’s because the accidental death insurance won’t pay out in that case.
Absent any other life insurance, those families would have to pay for the funeral out of any money you left if any or out of their own pocket.
When faced with this problem, it’s not usual to think that when someone dies unexpectedly of natural causes that it should be considered an accidental death.
After all, the person didn’t mean to die.
It must have been an accident right?
Unfortunately, life insurance companies don’t look at it that way. How old you were when you died isn’t a factor.
It’s the how you died that really matters.
Another reason how you died is important is because the amount of life insurance paid out on an ordinary life insurance policy might depend on how you died.
If you had an accidental death benefit rider or other accident benefits, the insurance company may have to pay out more if it was an accident.
How do insurance companies know you died in an accident?
Before an insurance company will consider a death to be an accidental death, they will need to know the specific cause of death. They get that information from what’s called a certified death certificate.
When you submit a claim to the insurance company, you have to include a certified death certificate with the claim to prove not only that the insured died, but also how the insured died.
When you look at a certified death certificate, it it says the insured died of carcinoma of the lung that would not be considered an accident.
That’s because lung cancer is an illness not an accident.
But if the death certificate said that the person died in a car accident, then the insurance company would treat the claim as an accidental death and cover it as such.
In most states, the death certificate lists the cause of death. However, there are some states that don’t list the cause of death on the death certificate.
When that happens, the insurance company will have to conduct an investigation.
Usually, the funeral home will help you get certified death certificates.
But if not, here’s a state-by state-listing of how to order a death certificate if you need it.
Be aware of accidental death insurance exclusions
Certain types of deaths not caused by illness would not be considered “accidental” by the insurance company. The most common thing people wonder is suicide considered an accidental death.
Suicide is not considered an accidental death because it is a self inflicted injury.
Depending on what state you live in, most ordinary life insurance policies have a suicide clause which excludes payment for suicide in the first one to two years a policy is in force.
However, with accidental death insurance benefits, suicide is always excluded. People have asked how to make a suicide look like an accident, but that’s insurance fraud which you want to stay away from.
Here are some other types of exclusions you might see:
- Intentional self-inflicted injury like an accidental overdose with an illegal drug
- Act of war
- Killed while committing a felony
- Pilot or crew member of plane that crashed
Other examples of exclusions you might see are:
- Benefits might terminate at a certain age like age 70
- An accident policy that only covered off the job accidents would not pay for an on the job accidental death.
In every accidental death policy or rider, there are a list of exclusions. You’ll want to be sure to check out the exclusions listed in your policy.
Tips for filing an accidental death insurance claim
When you file an accidental death claim, here are some things you will want to do.
- Identify all life insurance policies in force Find all the life insurance polices that the person had. You still want to file claims for all non accidental deaths. Locate the actual policies if you can. This will tell you if they were accident only policies, if there were any additional accidental death benefit riders (sometimes called double indemnity).
- Identify all accidental death benefits You’ll want to find all policies that pay accidental death benefits. This would include any individually owned accidental death insurance, group life insurance at work with an accidental death benefit rider, other group or individual accident plans that have accidental death benefits included, accidental death benefit riders, accidental death policies purchased at banks or through credit cards and any travel accident plans if you were traveling.
- Was it a common carrier accident? Some insurance policies are only for common carrier accidents. Some insurance policies pay an additional benefit if the accidental death was a common carrier accident. An example of a common carrier accident is one where you are a commercial passenger on a bus, plane or train. Usually this is when you buy a ticket for this transportation. Always make sure the insurance company knows if it’s not only an accident but a common carrier accident in case that might pay an additional benefit.
- Claim any additional accident benefits If there was a base accident policy that pays for other injuries and there are any additional benefits eligible for payment, claims those as well. For example, if the accident policy pays for broken bones and a bone was broken, file a claim for it along with the accidental death claim.
- Review all accidental policies for exclusions and other policy provisions If someone died of a skydiving accident and it’s listed as an exclusion, you’ll know right away that it’s unlikely that policy will pay. If you can’t find the contracts, which is often the case, don’t worry about it. Just do the best you can.
- Review the cause of death on the certified death certificate BEFORE you file your accidental death claim If you believe a person died in an accident but the death certificate says they died of a heart attack, find out why before you file the claim. If it’s a mistake, it’s better to get it fixed before you file your claim with the insurance company.
- Consult with an attorney if the cause of death is unclear or someone else caused the accidental death It’s not always easy to say what is and what is not an accidental death. If there’s good reason to think the death was due to an accident but the death certificate doesn’t list the cause as accidental, you might contact an attorney for help before you file a claim. In addition, if the death was caused by someone else, you may also have a valid legal claim that might be related to another type of insurance claim (like auto insurance for example) or another person’s legal liability as well.
- Include any evidence the death was an accident with the claim form Make the insurance companies job easier by providing any supporting evidence with the claim that the death was indeed an accident. This could include newspaper articles, printed or on the web, as an example.
- Always file a claim when it’s not clear if it was an accidental death With most accidental deaths, it will be easy to know if the insured died in an accident. Things like an auto accident or gunshot are pretty cut and dried. But sometimes, it’s not so easy to tell. For example, someone could have a heart attack and then die in an auto accident. Is that an accident or natural causes? People present me with scenarios all of the time. It’s pretty complicated to know for sure in some cases and the only way you know for sure is by filing a claim. Ultimately, the death certificate is probably going to be what the insurance company goes by. The important thing is to always file a claim when you are not sure. Don’t decide for the insurance company. Make them decide.
I hope those tips help you file any claim you might have.
After you have filed your claim, then you wait for payment. But what if the insurance company denies the claim.
What do you do then?
What to do if the insurance company denies the accidental death claim
I once had an employee tell me that his father had died and the death certificate listed the death as a heart attack. However, the circumstances of where he died and what he was doing led the employee to a different conclusion.
Evidently, his father raised cattle and he was found out in a field. The employee told me that he believed the father was rushed by one of the cattle and struck in the chest which caused his heart to stop and he died.
In order to prove that to the insurance company, he had to have the insurance company investigate the claim. An autopsy was performed and it turned out his theory was right and he was killed by one of the cattle. The cause of death was changed on the death certificate.
Then, his father’s death was ruled accidental and the insurance company paid the claim that way.
If you believe you have a legitimate accidental death claim, but the insurance company denied it, there are a few other avenues you could explore.
- Ask the insurance company to investigate
- Ask an attorney for legal help
- File a complaint with your states department of insurance
Again, these steps would be for a legitimate complaint. If there was no accident it won’t help you get an accident policy to pay.
Remember that the death certificate will be the main source of information that the insurance company has to determine if a death was due to an accident.
The insurance company may obviously investigate any accidental claim regardless of what the death certificate says. I once had an employee die of an accidental gunshot which was eventually ruled a suicide and unfortunately didn’t pay a death benefit.
Medical examiners do a pretty good job of listing the proper cause of death on the death certificate and that’s the overriding factor in determining whether an insurance company will treat a death as accidental death or not.
If you have any questions, let me know in the comments and I’ll try to help.