The FEGLI Lawyer™
FEGLI Accidental Death Claim Lawyer
FEGLI accidental death claims are denied more than any other federal life insurance benefit. MetLife's exclusion defenses are contestable under federal law — but only when the claims record is built to support that challenge. That work begins at the initial claim, not after a denial.
What FEGLI's Accidental Death Benefit Provides
Under FEGLI's Basic coverage, federal employees who die through accidental means may be entitled to an additional benefit — the accidental death and dismemberment benefit, commonly referred to as AD&D — that is paid in addition to the regular life insurance proceeds. The amount depends on the employee's age at the time of death and the Basic coverage amount in force. For younger employees, the additional benefit can be substantial.
This benefit is separate from the regular FEGLI life insurance benefit under Basic, Option A, Option B, and Option C coverage. A surviving family that has already received FEGLI life insurance proceeds may still have an outstanding accidental death claim. A denial of one does not affect entitlement to the other.
The accidental death benefit is also among the most frequently contested FEGLI claims. To pay it, OFEGLI — the Office of Federal Employees' Group Life Insurance, administered by MetLife under contract with the Office of Personnel Management — must be satisfied that the death meets a specific legal standard under federal law. When that standard is disputed, or when OFEGLI invokes an exclusion, the benefit is denied. Those denials are often worth challenging.
How FEGLI Defines an Accident — and Why the Definition Matters
The FEGLI Policy requires that the insured have sustained bodily injuries "solely through violent, external and accidental means" and that death result "as a direct result of such bodily injuries independently of all other causes." Under federal common law, the standard for what constitutes an "accident" under the FEGLI Policy is well-established:
Federal Common Law — The Controlling Standard
Under federal common law, an "accidental death" is an event which is "fortuitous, unexpected, or unanticipated, which cannot be reasonably foreseen."Wickman v. Northwestern Nat'l Ins. Co., 908 F.2d 1077 (1st Cir. 1990), cert. denied, 498 U.S. 1013 (1991). Federal law governs the payment of FEGLI proceeds. Belcher v. Metropolitan Life Ins. Co., 943 F.2d 51 (6th Cir. 1991).
MetLife's interpretation of "accident" and the exclusions it invokes must be measured against this federal legal standard — not against whatever OFEGLI believes the standard to be. Federal courts have held that the definition is unambiguous. What OFEGLI characterizes as an exclusion, and how it characterizes the cause of death, is subject to that legal scrutiny. The gap between how OFEGLI applies the standard and what federal law actually requires is often where contested accidental death claims are won.
How OFEGLI Denies FEGLI Accidental Death Claims
OFEGLI's denials in accidental death cases follow a small number of recurring patterns. Each pattern has specific legal vulnerabilities. Understanding which one applies to a given claim is the first step toward contesting it.
The Physical or Mental Illness Exclusion
The most commonly applied exclusion. OFEGLI denies the accidental death benefit when it concludes that a physical or mental illness caused or contributed to the death. The problem: the exclusion requires an identified illness — not a symptom, a sign, or a medical event that suggests a possible underlying condition. When OFEGLI invokes this exclusion, the specific pre-existing illness must be named and its causal role established. Vague references to a "pre-existing disorder" or the characterization of a symptom as an illness do not satisfy that standard.
The "Independently of All Other Causes" Argument
OFEGLI uses this policy language to deny claims where any medical factor was present at or before the time of death — treating co-occurrence as causation. Federal courts apply a different standard: whether the bodily injury was the direct, proximate cause of death. The existence of a concurrent medical factor does not automatically disqualify an accidental death claim. The question is what actually caused the death, not what else existed at the time.
The Death Certificate Classification Problem
OFEGLI sometimes treats the absence of "accident" on the death certificate as grounds for denial. This position is not supported by the FEGLI statute, its governing regulations, or OPM's FEGLI Handbook. How a certifying physician characterizes the manner of death on a state vital records form does not determine whether the death satisfies FEGLI's specific federal legal standard. These are two distinct determinations — the answer to one does not control the answer to the other.
The Undefined "Pre-existing Disorder" Denial
OFEGLI sometimes denies the accidental death benefit by stating that the cause of death "was contributed to by a pre-existing disorder" — without identifying the specific disorder, explaining how it caused the death, or addressing what actually injured the insured. A denial that does not identify the illness, establish its causal role, and connect it to the specific exclusion language may be legally deficient. The burden of establishing the exclusion is on OFEGLI, not on the claimant to disprove it.
Why the Claims Record Determines What Is Possible Later
FEGLI accidental death claims that are contested at OFEGLI commonly proceed to administrative appeal — and sometimes to federal court. At both stages, what is available for review is largely limited to what was placed in the administrative record during the claim and appeal process. Evidence that was not submitted during those stages is generally unavailable later.
Our approach to every FEGLI accidental death case begins with the same question: what would we need to show in court to win? Every document submitted to OFEGLI, every argument made in the claims process, and every piece of medical evidence obtained answers back to that question.
The 90-day appeal window is the last opportunity to complete the record. What goes in — and what stays out — is often what determines the outcome in federal court.
In accidental death cases specifically, this means developing the medical evidence during the administrative process — not after. The relationship between a medical event and the physical injury, the distinction between a symptom and an illness, the question of what actually caused the death, and the deficiencies in how OFEGLI applied its exclusions all must be addressed in the record before a court ever sees the case. Early involvement is not just beneficial — in accidental death disputes, it is often the determining factor in what remains possible.
If you are filing a FEGLI accidental death claim — or anticipating that one will be contested — a free case evaluation helps you understand what is at stake before OFEGLI acts.
Free FEGLI Case EvaluationIf Your Accidental Death Claim Has Already Been Denied
This page addresses the initial claims stage. If OFEGLI has already issued a denial, the next step is a formal administrative appeal. You have 90 days from the denial letter date to challenge OFEGLI's findings — and that window is the critical opportunity to build or supplement the record before the case can proceed to federal court.
Frequently Asked Questions About FEGLI Accidental Death Claims
What is FEGLI's accidental death benefit, and how is it different from regular FEGLI life insurance?
FEGLI's accidental death and dismemberment benefit — commonly called AD&D — is a separate, additional benefit paid on top of the regular FEGLI life insurance proceeds when a federal employee dies through accidental means. Receiving the regular life insurance benefit does not satisfy or preclude the accidental death claim; they are independent benefits. The life insurance benefit is determined by enrollment and coverage elections. The accidental death benefit requires that the death meet a specific federal legal standard for what constitutes an accident under the FEGLI Policy.
What does FEGLI require to pay an accidental death benefit?
The FEGLI Policy requires that the employee have sustained bodily injuries "solely through violent, external and accidental means" and that death result "as a direct result of such bodily injuries independently of all other causes" within one year of the injury. Under federal common law, an "accidental" death is one that is fortuitous, unexpected, and not reasonably foreseeable. Both the nature of the injury and the cause of death are examined against this standard, which is set by federal law — not state law or MetLife's internal guidelines.
What is the most common reason OFEGLI denies FEGLI accidental death claims?
The most common denial basis is the "physical or mental illness" exclusion. OFEGLI denies accidental death benefits when it concludes that a physical or mental illness caused or contributed to the death. This exclusion is frequently applied — and frequently applied more broadly than federal law permits. The exclusion requires an identified illness, not a symptom, sign, or medical event that occurred near the time of death. When OFEGLI invokes this exclusion without identifying the specific illness or establishing its causal role, the denial may be legally deficient and subject to challenge.
Does a preexisting health condition automatically disqualify a FEGLI accidental death claim?
No. A preexisting health condition does not automatically eliminate the accidental death benefit. The relevant question is whether the death resulted directly from a bodily injury sustained through accidental means, independently of other causes. The presence of a health condition — or a medical event that preceded the injury — does not answer that question. OFEGLI must establish that an identified illness caused or materially contributed to the death. Where the evidence shows that the bodily injury was the proximate cause of death, the existence of a background condition is not sufficient grounds for denial under the exclusion.
What if the death certificate does not list the cause of death as accidental?
The classification on a death certificate does not control whether FEGLI's accidental death benefit is owed. OFEGLI sometimes treats the absence of "accident" on a death certificate as grounds for denial — but this position is not supported by the FEGLI statute, its governing regulations, or OPM's FEGLI Handbook. The question is whether the death satisfies FEGLI's federal legal standard for accidental death. That is a legal determination under federal law. How a certifying physician characterized the death on a state vital records form is a separate matter, and the two should not be conflated.
My family member died from injuries sustained in a fall. OFEGLI says a medical event caused the fall and is denying the claim. Is the claim lost?
Not necessarily. A fall is a violent, external event. The question — and the legal analysis — turns on two specific issues: whether the physical injuries from the fall were the direct cause of death, and whether any medical event that preceded the fall constitutes a "physical or mental illness" as the FEGLI exclusion requires. OFEGLI sometimes characterizes symptoms or physiological events as "illnesses" without identifying the specific underlying condition. A symptom is not the same as an illness under federal law, and OFEGLI's burden is to identify the illness and establish its causal role. These are precisely the kinds of factual and legal questions where early legal analysis makes a significant difference in what remains possible.
What does "independently of all other causes" mean in the FEGLI Policy, and how does OFEGLI use it?
The FEGLI Policy requires that death result "as a direct result of such bodily injuries independently of all other causes." OFEGLI sometimes reads this language to mean that any co-occurring medical factor — however peripheral to the actual cause of death — disqualifies the claim. Federal courts apply a different standard: whether the bodily injury was the direct, proximate cause of death. The existence of a concurrent condition does not automatically eliminate the benefit. The relevant legal question is causation, not co-occurrence — and the two standards produce different outcomes in many contested cases.
What should I do if OFEGLI denies my FEGLI accidental death claim?
You have the right to file a formal administrative appeal. The appeal must be submitted within 90 days of the denial letter date. That window is not just a procedural deadline — it is the last opportunity to add evidence, expert analysis, and legal argument to the administrative record before the case can proceed to federal court. How that appeal is built — what goes into the record and how the legal arguments are framed — has direct consequences for what is available if litigation follows. If a denial has already been issued, the most important step is to act before the 90-day window closes.
Free FEGLI Accidental Death Case Evaluation
Whether you are making an initial claim, responding to a denial, or trying to understand what an exclusion means for your situation — a free evaluation is the right starting point. We assess the case honestly, explain what the law requires, and tell you where you stand.
Speak with a FEGLI Lawyer