My AD&D (accidental death) claim was denied because of drugs. Can they do that, and what can I do?

Life insuranceDeniedChecked Nov 7, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-07 · Source: National Association of Insurance Commissioners · Uniform Individual Accident and Sickness Policy Provision Law (Model 180) · Section 3B(9)(a) View original ↗

In short

Some accident plans do not pay if drugs caused the loss.
Model words let a drug a doctor gave still count.
A job plan gives you at least 60 days to appeal.

What this means

Accident policies can include an exclusion for intoxication or narcotics. A model law from the NAIC gives this wording for individual accident policies. It excludes a loss "in consequence of" being intoxicated or under the influence of a narcotic, "unless administered on the advice of a physician" [1]. So the exact words matter, and so does whether a doctor advised the drug.

This model is only a suggestion for states that want it [2]. It also does not apply to group policies [3]. If your AD&D came through a job, read the exclusion in your own certificate.

For a job plan, the denial notice must give the specific reason and the plan rule it used [4]. You get at least 60 days after the denial notice to appeal [5]. You can ask, free of charge, for copies of the records the plan used [6]. Rules in your state may differ.

Your next step

Get the denial letter and the exact drug or intoxication exclusion in the policy or certificate [1]. If the plan came through a job, appeal in writing within 60 days of the denial notice [5]. Ask for the claim file in the same letter [6].

Check it yourself

Read the exclusion word for word, and note whether a doctor prescribed the drug. Whether your state uses this model wording is not in these sources — "Don't know yet". For a policy you bought yourself, the appeal time is not in these sources — "Don't know yet". Rules in your state may differ. Ask your state insurance department or a lawyer.

Where this comes from (6)

[1] National Association of Insurance Commissioners · Uniform Individual Accident and Sickness Policy Provision Law (Model 180) · Section 3B(9)(a) · checked 2026-11-07
Intoxicants and Narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.
[2] National Association of Insurance Commissioners · Model 180 · Section 3B drafting note · checked 2026-11-07
Drafting Note: Paragraphs (9) and (10) are suggested for states which desire such provisions.
[3] National Association of Insurance Commissioners · Model 180 · Section 8 · checked 2026-11-07
Nothing in this Act shall apply to or affect: … Any blanket or group policy of insurance;
[4] eCFR · 29 CFR 2560.503-1 · § 2560.503-1(g)(1)(i)-(ii) · checked 2026-11-07
The specific reason or reasons for the adverse determination; … Reference to the specific plan provisions on which the determination is based;
[5] eCFR · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(i) · checked 2026-11-07
Provide claimants at least 60 days following receipt of a notification of an adverse benefit determination within which to appeal the determination;
[6] eCFR · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(iii) · checked 2026-11-07
Provide that a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits.

How we found this

We matched your question to 6 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-07.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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