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.


Asked on 3/31/99, 9:40 am

1 Answer from Attorneys

Edward Hoffman Law Offices of Edward A. Hoffman

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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Answered on 4/07/99, 7:13 pm


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