When a loved one dies in an accident or you experience a permanent, life-altering injury, it feels like the world around you has fallen apart. Amid all the grief you’re feeling, you face a mountain of confusing paperwork and new realities paired with financial uncertainty. Accidental death and dismemberment insurance exists to provide a financial foundation during this kind of crisis, but insurance companies frequently deny these claims by disputing the cause of death, pointing to medical history, or arguing that a policy exclusion applies.

If you have received an AD&D denial, you don’t have to accept an unfair decision. With the right help, you can understand why that happened and what options you still have.

About Roberts Disability Law, P.C.

Roberts Disability Law represents beneficiaries and survivors whose accidental death and dismemberment claims have been denied by insurance companies. Our attorneys focus specifically on claims governed by the Employee Retirement Income Security Act (ERISA), the federal law that controls most employer-sponsored AD&D policies.

Attorney Michelle Roberts built this firm around a simple conviction: employees and beneficiaries deserve an advocate who understands the tactics insurance companies use to avoid paying. That conviction grew out of watching her own father, a disabled Navy veteran, struggle against a system that made it difficult for him to get the support he needed.

After more than 20 years representing claimants against major insurers, Michelle has become a formidable opponent to the companies that try to deny, delay, or minimize valid AD&D claims. Roberts Disability Law, P.C. is a woman- and minority-owned firm, and our team, including Michelle Roberts, Monica Lienke, and Kristin Kyle, brings decades of combined experience litigating ERISA, life, and AD&D disputes against insurers like UNUM, MetLife, Reliance, Cigna, and Prudential.

Who We Serve

Every AD&D denial looks different, but most families and survivors find themselves in one of these situations:

• Families who received an AD&D denial they do not understand. A loved one died unexpectedly, and the insurer’s explanation for denying the claim is vague, incomplete, or does not match the actual circumstances of the death.
• Beneficiaries whose loved one’s medical history is being blamed for the death. The insurer argues that a preexisting health condition rather than the accident itself was the real cause of death and is using that argument to avoid paying benefits.
• Families told the circumstances of the death fall outside the policy. The insurer claims the death involved intoxication, a self-inflicted injury, a medical procedure, or another disputed scenario that it says is excluded from coverage.
• People denied benefits after losing a limb, their sight, or another covered function. A survivor of an accident suffered a permanent loss that should qualify for AD&D benefits, but the insurer denied the claim or claims the injury does not meet the policy’s definition.
• Beneficiaries facing an AD&D denial under an employer benefit plan. Because the coverage came through an employer, ERISA rules, strict appeal deadlines, and specific procedures now control what happens next, and one misstep can jeopardize the entire claim.

What You Should Know About AD&D Claims

ERISA Governs Most Employer-Sponsored AD&D Policies

ERISA preempts most employer-sponsored AD&D plans. In other words, federal law rather than state contract or bad faith law determines your rights and remedies. When ERISA applies and a dispute arises, courts will weigh the insurance company’s financial conflict of interest since the same company that decides your claim also pays it.

Notice and Filing Deadlines Matter, But They Are Not Always Set in Stone

Some AD&D plans require notice of a claim within a certain timeframe. For example, if an insurance policy funds the plan, state insurance law may include a “notice-prejudice rule” that prevents the insurer from denying a claim solely because it arrived late. That said, if the policy also sets a deadline for filing a lawsuit, your claim could still be time-barred. These rules intersect in complicated ways, and an attorney familiar with ERISA can help you understand your options.

Many families overlook the fact that long-term disability claimants are often eligible for a waiver of the life insurance premium on their life and AD&D policies. Reviewing the applicable plan documents to check for this benefit is worth the effort.

Whether a Death Was an “Accident” Is Often Disputed

A central question in many AD&D disputes is whether the death or injury actually qualifies as an “accident.” Courts have addressed this issue repeatedly, including in Tyler v. AIG Life Insurance Co., where the Eleventh Circuit held that when a policy does not define “accident,” courts should look to analogous state law for guidance. This fact-specific inquiry often becomes the crux of the entire dispute.

Common Exclusions Insurers Rely On

Insurers often try to justify their denials by pointing to policy exclusions. However, the Ninth Circuit, which covers California, applies a “substantially contributed” test for preexisting conditions. A prior health condition will not prevent coverage unless it substantially contributed to the death or injury. Beyond preexisting conditions, watch for these common exclusion arguments:

• Suicide. Did the decedent expect to die as a result of their actions, and would a reasonable person have viewed the injury as highly likely given the insured’s intentional conduct?
• Intoxication. Insurers may argue that a death occurring while driving under the influence was self-inflicted rather than accidental.
• Course of employment. Some plans limit benefits to accidents that occurred while the insured was working.
• Medical risk. Insurers sometimes argue that a death resulting from a medical procedure or a known medical risk does not qualify as accidental.

Our Process for Fighting Your AD&D Denial

When you work with Roberts Disability Law, P.C. on an AD&D claim, we handle every stage of the battle:

1. Case evaluation. We review your policy, the insurer’s denial letter, and the circumstances of the accident or injury to identify the strongest basis for appeal.
2. Investigation. We work closely with trained experts to investigate the accident scene or the circumstances surrounding the death, building the factual record the insurer’s decision often lacks.
3. Policy and legal analysis. We examine the AD&D policy language alongside the applicable law, including ERISA regulations and relevant court decisions, to pinpoint where the insurer’s denial falls short.
4. Appeal preparation and submission. We prepare a thorough administrative appeal, presenting medical evidence, expert opinions, and legal arguments designed to overturn the denial before litigation becomes necessary.
5. Litigation, if necessary. If the insurer upholds its denial, we advocate on your behalf in federal district court and, when appropriate, before the U.S. Courts of Appeals.

Throughout this process, we keep you informed of what is happening and what to expect next, so you are never left wondering where your case stands.

Why Choose Roberts Disability Law, P.C.?

• Deep ERISA and AD&D experience. Our attorneys focus specifically on claims governed by ERISA, including the technical rules unique to AD&D policies that general practice firms often miss.
• A track record against major insurers. We have gone up against companies like UNUM, MetLife, Reliance, Cigna, Prudential, and The Hartford, and we understand the tactics they use to justify denials.
• Personal investment in every case. Michelle Roberts built this firm on a personal mission to help people facing powerful insurance companies, and that mission shapes how our whole team approaches every claim.
• Full-service representation. From the initial claim through appeal and, if needed, federal litigation, we handle every stage so you do not have to face the insurer alone.
• Recognition for excellence. Our firm has been named to the Law Firm 500 and is recognized as a woman- and minority-owned practice with a strong record of client satisfaction.

Get the Benefits Your Policy Promised

An AD&D denial is not the final word. When the medical evidence, policy language, and law are cross-examined, the reasons for insurers’ denials often fall apart. If your family has been told a death does not qualify or if you were denied benefits after a permanent injury, schedule a free, no-obligation review of your case with Roberts Disability Law today.

Frequently Asked Questions