Accidental Injury

Injuries resulting from a suicide attempt — Medical expense policies routinely exclude intentionally self-inflicted injuries and suicide attempts — the classic self-inflicted injury exclusion. The exclusion rests on the principle of fortuity: insurance covers accidental, unintended losses, not injuries the insured deliberately causes to himself. An injury from a suicide attempt falls squarely within that exclusion, even though medical treatment will generally still be provided and the provider can seek payment from other sources. Fortuity is the anchor of insurable coverage: the loss must be unintended and unexpected.

National insurance concept

Medical expenses payable under a state workers' compensation law — Major medical policies commonly contain an other-insurance exclusion for medical expenses that are payable under a workers' compensation law. Because the employer's workers' compensation coverage is statutorily responsible for on-the-job injuries, the major medical policy steps aside to avoid duplicate payment — the two coverages never pay twice for the same bill. Surgery after an accidental injury, hospitalization for a covered illness, and physician-ordered outpatient testing are all ordinary covered benefits with no other compulsory payer. Coordination with workers' compensation is handled by an other-insurance provision so the claimant receives full reimbursement of covered expenses from a single responsible source and the two policies do not pay the same bill twice.

National insurance concept