Which injury is MOST likely to be excluded under a typical individual major medical expense policy?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Major medical policies routinely exclude intentionally self-inflicted injuries — most prominently suicide attempts and injuries sustained while committing an illegal act. The principle behind the exclusion is fortuity: insurance indemnifies against accidental, unintentional losses, and a deliberately caused injury is not fortuitous. If intentionally self-inflicted harm were covered, the policy would create a perverse incentive and violate the requirement that covered losses be uncertain. Injuries from sports, auto accidents, and ordinary household accidents, by contrast, are accidental and fortuitous, which is why they fall within the policy's protection rather than its exclusions.
Why the other options are wrong
- B) A recreational sports injury is an accidental, fortuitous loss and is covered under major medical insurance, so it is not the kind of deliberate harm the exclusion targets.
- C) Automobile accident injuries are standard covered losses regardless of who was at fault, because they are accidental events rather than intentionally caused injuries.
- D) A household cooking burn is an accidental injury and is covered under the policy, so it falls on the covered side of the fortuity line.
Memory hook
Insurance pays for accidents, not intentions. Deliberate self-injury stays outside the policy door.