Which statement best describes the coverage requirement for injury under an accident and health policy?

• A. The accident must be external and violent
• B. The cause of the accident must be intentional
• C. Only the injury resulting from an accident must be unintentional
• D. Both the cause and the result of an accident must be unintentional

Answer: (D)

The idea being tested is that coverage in an accident and health policy hinges on unintentional harm. An accident must be an unplanned, unintended event, and the injury it causes must also be unintentional. If the incident is deliberate or the injury is intentional, the claim is typically not covered. That’s why the statement that both the cause of the accident and the resulting injury must be unintentional is the best description. For example, slipping on a wet floor is an unintentional accident and the resulting injury is unintentional, so it would generally be covered (subject to other exclusions). Deliberate harm or self-inflicted injuries are usually excluded.