General Insurance✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
An insured forgets to take prescribed medication, falls, and is injured. The health insurer pays the claim because:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A fortuitous loss is one that is accidental and unexpected from the insured's perspective. The insured did not intend the fall or the injury, even though carelessness contributed. Ordinary negligence does not defeat fortuity; only intentional or self-inflicted acts do. This is why insurers pay claims arising from accidents involving some degree of carelessness while excluding deliberately caused losses.
Why the other options are wrong
- B) The insured may well have been careless; fault is not the test - intent is.
- C) Health policies contain exclusions (e.g., intentionally self-inflicted injuries, certain experimental treatments) and do not cover everything.
- D) Prompt notice is a claim-processing requirement, not the reason coverage exists.
Memory hook
Careless but not intentional = still fortuitous. Fault is not fraud.