What Does Accidental Death and Dismemberment Insurance Cover?

Accidental death and dismemberment insurance covers two things: a lump-sum death benefit if a covered accident kills you, and a scheduled percentage of that benefit if a covered accident causes you to lose a limb, your sight, your hearing, your speech, or your ability to move. It pays only when the cause is a genuine accident, and every policy carries a list of exclusions that decide whether a given event qualifies.

AD&D is not a replacement for life insurance or health insurance. It sits alongside them and adds money for the narrow set of sudden, catastrophic events that fit its definition of an accident.

The Accidental Death Benefit

If you die as a direct result of a covered accident, your beneficiary receives the full policy amount as a lump sum. The death must result directly and independently from an accidental injury that was unintended, unexpected, and unforeseen.¹ That “directly and independently” language is what separates AD&D from life insurance, which pays out for almost any cause of death.

The death doesn’t have to be instant. Policies give you a window, commonly 365 days from the date of the accident, during which a death caused by accident injuries still triggers the benefit.² Covered incidents typically include car crashes, falls, drowning, workplace accidents, and transportation incidents like plane crashes. Some policies also cover deaths from extreme weather exposure.

Benefit amounts usually run from $25,000 to $500,000, depending on what you select or what your employer provides.¹ Group AD&D through work often matches your base life insurance amount. Individual policies let you pick higher limits.

Exposure and Disappearance

Most policies extend coverage to situations where no body is recovered. If you disappear after the sinking, wrecking, or disappearance of a vehicle you were traveling in, insurers generally presume death after 12 months and pay the benefit.³ These provisions typically treat exposure to the elements as a covered injury too, so dying of exposure after an accident but before rescue is still covered.

Dismemberment: The Schedule of Losses

Dismemberment benefits pay a percentage of your total policy amount based on what you lost. Every AD&D policy contains a schedule that lists covered losses and the exact percentage each one pays. The loss must occur within a set period after the accident, commonly 365 days.

Loss of Limbs

Losing a hand or foot typically pays 50% of the full policy amount. Losing an arm or leg at or above the elbow or knee often pays 75%. Losing any combination of two or more limbs, or a limb combined with your eyesight, generally pays 100%. Some policies also cover fingers and toes: losing a thumb and index finger on the same hand, or four fingers on the same hand, may each pay 50%.⁴

“Loss” traditionally means severance, but many modern policies also cover permanent loss of use. If nerve damage from an accident leaves an arm attached but completely nonfunctional, those policies pay the same as if the limb were severed. This varies significantly between insurers, so the definitions section of your policy is the place to check.

Loss of Vision

Losing sight in one eye generally pays 50%. Total blindness in both eyes pays 100%.⁴ The bar is high. “Loss of vision” almost always means total and permanent blindness in the affected eye, meaning you cannot perceive light or shapes even with correction or surgery. Reduced clarity or partial vision loss does not qualify. Insurers require records from an ophthalmologist and sometimes additional testing like visual field exams.

Loss of Hearing or Speech

Hearing in one ear typically pays 50%; complete deafness in both ears pays 100%. Total and permanent loss of speech is often eligible for a full payout as well. As with vision, the loss must be complete and permanent. Partial hearing loss or difficulty speaking clearly doesn’t qualify, even if it significantly affects your daily life. Documentation from an audiologist or speech specialist is required, tying the loss to the accident.

Paralysis and Coma

Paralysis is one of the largest categories of AD&D payouts and one of the most heavily documented. Policies break it into categories by severity. Using a representative schedule:

Quadriplegia (all four limbs): 100% of the full amount
Paraplegia (both legs): 75%
Triplegia (three limbs): 75%
Hemiplegia (arm and leg on the same side): 50%
Monoplegia (one arm or one leg): 25%

On a $250,000 policy, that works out to $187,500 for paraplegia, $125,000 for hemiplegia, and $62,500 for monoplegia.⁴ These percentages vary between insurers, so your own policy’s schedule is what governs.

Claim documentation for paralysis is heavier than for other losses. Insurers want neurological assessments, imaging like MRIs, and physician statements confirming the paralysis is permanent and directly caused by the accident. When symptoms develop gradually or worsen weeks after the initial injury, disputes are more likely. Progressive nerve damage and spinal cord swelling that extend beyond the initial trauma are common friction points. Prompt reporting and thorough medical records from day one make the difference.

Coma

Some AD&D policies pay a coma benefit if a covered accident leaves you comatose. It’s usually structured as a monthly payment rather than a lump sum. A common structure pays 1% of the full policy amount per month for up to 100 months, so a $200,000 policy would pay $2,000 a month for as long as the coma persists, up to the cap.⁴ Not every policy includes this, so look for it if it matters.

Add-On Benefits That Increase the Payout

Beyond the core schedule, many policies stack extra benefits on top when specific circumstances apply.

Common Carrier Benefit

If you die in an accident while riding on public transportation such as a plane, bus, train, or ferry, many policies pay an additional benefit on top of the standard death payout, often equal to the full policy amount, effectively doubling it.⁵ “Common carrier” means a vehicle operated for regular passenger service on established routes. Commercial flights and scheduled transit count; ride-shares and private charters do not.

Seatbelt and Airbag Benefits

Some policies pay extra if you die in a car accident while wearing a seatbelt. A typical seatbelt benefit adds 10% of the policy amount up to $25,000. If an airbag also deployed, an additional 5% may apply up to $10,000. When both apply, the combined extra is capped at 15% of the policy amount or $20,000, whichever is less.⁶

Education Benefit

Some AD&D policies include a tuition benefit for your dependent children if you die from a covered accident. Structures vary widely. Some pay a flat amount per child per year of school; others cover a percentage of tuition up to a cap. If this matters to your family planning, confirm the specifics in the policy itself, because it’s the least standardized of the extras.

What AD&D Does Not Cover

Claims are usually denied not because the injury was too minor, but because the cause fell into an exclusion. The common ones:

Illness or natural causes. If a heart attack causes you to crash your car, the death resulted from illness, not an accident. AD&D will not pay. This is the single biggest source of denied claims and the reason AD&D is not a substitute for life insurance.
Suicide or self-inflicted injury, regardless of the insured’s mental state.
Intoxication or drug use at the time of the accident. The threshold varies. Some policies use the legal blood alcohol limit, others use broader language about being under the influence.
Injuries sustained while committing or attempting to commit a felony.
War, military action, or acts of war, declared or undeclared.
Hazardous activities such as skydiving, mountaineering, motor racing, and paragliding. Some policies cover these for an additional premium; others exclude them outright.
Medical or surgical treatment, unless the procedure was treating the accidental injury itself.

The insurer keeps the right to have you medically examined at their expense while a claim is pending, and in death cases they may request an autopsy where law permits.¹ These tools exist to check whether an exclusion applies. Documentation that establishes the accidental nature of the event is what carries a claim through.

How Much Coverage Costs

AD&D is among the cheapest coverage you can buy because it only pays for a narrow set of events. Group rates through an employer can run as low as roughly $0.03 per $1,000 of coverage per month.⁷ At that rate, $100,000 of coverage costs about $2.80 a month. Individual policies cost more but are still modest compared with term life. Premiums generally don’t vary by age or health, which is why employers bundle AD&D into benefit packages.

The low price is also a signal. AD&D pays out far less often than life insurance because most deaths aren’t accidental. If your family needs reliable income replacement, term life is the foundation. AD&D works as a supplement on top of it.

Filing a Claim

Notify the insurer as soon as possible after the accident. Many policies set a deadline for initial notice, often 20 to 30 days. Missing it doesn’t automatically void the claim, but it gives the insurer grounds to push back.

After notice, the insurer sends a claim form asking for the insured’s information, the policy number, and a detailed description of the accident. Supporting documents are the core of the claim. A death claim requires a certified death certificate and usually a police report or paramedic records. A dismemberment or paralysis claim requires medical records including surgical reports, imaging, and physician statements confirming the injury is permanent and directly caused by the accident. Insurers may also ask for an attending physician statement linking the injury to the specific incident.

Most insurers complete their review within 30 to 60 days after receiving all required documents.² Independent medical evaluations at the insurer’s expense can add weeks.

If a Claim Is Denied

The insurer must give a written reason. For group AD&D through an employer, federal law under ERISA sets the appeal framework: you have at least 60 days from receiving the denial to appeal, and the plan has 60 days after that to decide.⁸ You can submit new evidence and review the documents the insurer used to deny the claim. Individual policies outside ERISA follow the appeal terms in the policy and applicable state law.

Documentation from the moment the accident happens is what protects a claim. Medical records, police reports, witness statements, photographs, and a written timeline all strengthen the connection between the accident and the loss. The claims that fall apart are almost always the ones where that connection is thin, not the ones where the severity of the loss is in doubt.

1
Minnesota Life Insurance Company. Accidental Death and Dismemberment Certificate of Insurance
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Minnesota Life Insurance Company / State of Maryland. Accidental Death and Dismemberment Certificate of Insurance
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State of Michigan. Accidental Death and Dismemberment (AD&D)
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MetLife / Los Alamos National Laboratory. Retiree Voluntary Accidental Death and Dismemberment (AD&D) Insurance
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NEI Benefit Solutions. Accidental Death and Dismemberment (AD&D) Insurance
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FBMC Benefits Communications / MetLife. Accidental Death and Dismemberment Description of Benefits
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The Standard. Group Additional Life and AD&D Insurance
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eCFR. 29 CFR Part 2560 – Rules and Regulations for Administration and Enforcement