A medical expense policy commonly excludes injuries or illnesses that are:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medical expense policies routinely exclude conditions that are covered under workers' compensation because workers' compensation is the primary, employer-financed system that pays for work-related injuries and occupational illnesses. If the group health policy also paid, the insured would receive duplicate benefits and the workers' compensation scheme would be undermined. The same exclusion logic commonly applies to other specified statutory coverages. This prevents double recovery while preserving the health policy for non-occupational care, making A the correct statement of a standard medical expense exclusion.
Why the other options are wrong
- B) A chronic illness diagnosis is not a blanket exclusion; modern policies cover chronic conditions subject to pre-existing condition rules and waiting periods, not an automatic first-year bar on the disease itself.
- C) Treatment by a large group practice is never excluded; the size, type, or organizational structure of a provider practice has no bearing on whether a service is covered under a medical expense policy.
- D) Policies contain timely-filing requirements that demand prompt claim submission, but coverage is not denied merely because treatment was billed 90 days after the service date, provided the claim is filed within the policy's limits.
Memory hook
Work comp is the first payer for on-the-job injuries; the health plan stays out to avoid double-dipping.