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:
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Answer & full 3-part explanation (select an option above, or peek)
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.