Legal Question in Insurance Law in Illinois
Coverage Denial
According to medical plan it states no coverage for intentionally inflicted
injury or illness whether sane or insane.
Patient diagnosed with chemical imbalance - mental illness (severe
depression). Insurance coverage for emergency medical treatment due to
suicide attempt denied on the above basis. Treatment for depression (non drug and alcohol based depression) after
patient out of hospital for medical part is covered.
Doctor agrees with me that Patient could not have intentionally inflicted this injury due to illness.
Have there been any cases won on the basis of the word intentional and what are our chances of winning.
1 Answer from Attorneys
Re: Coverage Denial
You say that the medical treatment was for a suicide attempt. Suicide is an intentional act, and the same is true of attempted suicide. While I am not licensed in your state, it seems to me that any injuries resulting from a suicide attempt would not be covered, as they would fall within the "no coverage for intentionally inflicted injury" language.
You seem to think the policy only talks about injuries inflicted due to the illness; if this is what you are thinking, then you are mistaken. The policy addresses injuries inflicted intentionally, regardless of whether the insured is sane or insane at the time or what led the insured to injure himself.
Sorry I can't be more encouraging.
Edward Hoffman
Law Offices of Edward A. Hoffman
11620 Wilshire Boulevard, #340
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