A typical medical expense policy excludes injuries or illnesses for which the insured:
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
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.