How to Challenge an Accidental Death Denial Based on “Voluntary Risk” Exclusions

When a loved one dies in an accident, an Accidental Death and Dismemberment (AD&D) insurance policy should provide financial relief. Instead, many families receive a denial letter claiming the death falls under a “voluntary risk” or “self-inflicted injury” exclusion. Insurance companies use these exclusions broadly, often stretching their meaning far beyond what the policy language actually supports.

A denial is not final. Families have real legal options to fight back.

The key strategies for challenging these denials include:

• Activity analysis: Distinguishing between inherently dangerous conduct and a common accident
• Policy language ambiguity: Arguing that the exclusion’s wording is vague or legally unenforceable
• Witness and expert evidence: Using testimony and forensic data to counter the insurer’s characterization
• Legal precedents: Applying established judicial tests to prove the death was accidental

How Does Activity Analysis Challenge a Voluntary Risk Denial?

Insurance companies often label any risky behavior as “voluntary,” but that framing does not hold up under legal scrutiny.

Activity analysis requires a careful look at what the person was actually doing at the time of death. Was the activity something a reasonable person might do in ordinary life? Was there any intent to cause harm?

Distinguishing Everyday Accidents From Inherently Dangerous Acts

Courts consistently draw a line between activities that carry some general risk and acts that are fundamentally dangerous by nature. Taking medication, driving a car, or even participating in recreational sports fall into the first category. These are not “voluntary risks” in the legal sense, even if something went wrong.

Documenting the specific circumstances of the accident matters enormously here. Evidence like police reports, medical records, and photographs of the scene can demonstrate that the death resulted from an unexpected accident, not a knowing acceptance of near-certain harm.

Can Vague Policy Language Work in Your Favor?

Yes, and this is one of the most powerful arguments available.

AD&D policies frequently define “voluntary risk” or “self-inflicted injury” in broad, ambiguous terms. Under ERISA and many state insurance laws, courts apply a rule of contra proferentem: when policy language is ambiguous, that ambiguity is construed against the insurer and in favor of the claimant.

If the exclusion does not clearly define what constitutes a “voluntary risk,” the insurer cannot simply apply it however it sees fit. A thorough review of the policy’s exact language, alongside applicable federal and state law, can reveal significant weaknesses in the insurer’s position.

What Role Do Witnesses and Forensic Experts Play?

Eyewitness accounts and expert testimony can directly contradict the insurer’s narrative.

Forensic experts can challenge autopsy findings, toxicology reports, and cause-of-death determinations. At Bartolic Law, we have demonstrated that post-mortem toxicology samples often overstate substance levels due to post-mortem redistribution, a fact that can completely change how a denial is evaluated.

Witnesses who can speak to the decedent’s state of mind, daily routine, and circumstances leading up to the accident add critical context that documents alone cannot provide.

Which Legal Tests Determine Whether a Death Was Truly Accidental?

Courts have developed specific standards to answer this question.

Understanding the Wickman Test

The Wickman test, widely applied in ERISA cases, asks whether a reasonable person in the insured’s position would have viewed the result of their action as substantially certain to occur. If a reasonable person would not have anticipated death or serious injury as a near-certain outcome, the death qualifies as accidental under the policy.

This is a fact-intensive analysis. Building a strong record, including medical history, circumstantial evidence, and expert opinion, is what separates a successful challenge from one that falls short.

Contact Bartolic Law to Challenge Your AD&D Denial

A denial based on “voluntary risk” or “self-inflicted injury” deserves a thorough legal review, not acceptance. Bartolic Law has extensive experience challenging AD&D denials in ERISA and state law cases, and we know how insurers construct these arguments and how to take them apart.

If your family received a denial after the loss of a loved one, contact Bartolic Law today. We will review your case and help you understand your options for fighting back.