A worker is injured on the job and files a claim under a personal medical expense policy. If the injury is covered by workers' compensation, the policy will generally:

Why A is correct

Medical expense policies typically exclude expenses for which benefits are payable under workers' compensation or other state-mandated disability laws. The exclusion prevents duplicate payment for the same injury: the employer's workers' compensation program is the designated source of medical benefits for work-related injuries. This is one of the standard common exclusions and limitations tested in the medical expense domain, alongside exclusions for self-inflicted injury and non-medically-necessary care. The exclusion reflects the principle that benefits should not duplicate the same covered expense.

Why the other options are wrong

• B) Paying in full without regard to workers' compensation would create a double recovery for the same medical bill, which the exclusion is designed to prevent. The exclusion operates to prevent that duplicate payment.
• C) Policies do not structure a repayment schedule against workers' compensation benefits; the exclusion simply bars the claim. The health policy simply does not respond at all to a workers' comp claim.
• D) There is no deductible-like split in which the health policy pays the first portion; the workers' compensation program is primary and the health policy excludes the claim. The workers' comp program is primary for workplace injuries.

Memory hook

Work injury + workers' comp = health policy stands down. No double-dipping on the same bill.

Why A is correct

Medical expense policies routinely exclude conditions that are covered by workers' compensation, because the workers' comp system is designed to be the exclusive remedy for work-related injuries. The exclusion prevents duplicate payment for the same loss and reflects that work injuries are underwritten separately by the employer. Similar coordination exclusions apply to other programs that are intended to be primary. This is a standard exclusion found in the common exclusions section of medical expense contracts. In addition to workers' compensation, common exclusions include care covered by other government programs and treatment that is experimental. The purpose of these exclusions is to avoid duplicate payment for the same loss while keeping premiums affordable for the risks that are actually covered.

Why the other options are wrong

• B) Care received within the provider network is exactly what the policy is designed to cover, not an exclusion.
• C) Using an HSA to pay for care does not exclude a condition; HSAs are simply a payment vehicle.
• D) Diagnoses made during a physical are covered subject to policy terms; preventive and diagnostic care is not a blanket exclusion.

Memory hook

If workers' comp steps in, the medical policy steps out. No double-dipping on the same injury.