Can a plan deny benefits otherwise provided for the treatment of an injury based on the source of that injury?
If the injury results from a medical condition or an act of domestic violence, a plan may not deny benefits for the injury – if it is an injury the plan would otherwise cover. For example, a plan may not exclude coverage for self-inflicted injuries (or injuries resulted from attempted suicide) if the individuals injuries are otherwise covered by the plan and if the injuries are the result of a medical condition (such as depression). However, a plan may exclude coverage for injuries that do not result from a medical condition or domestic violence, such as injuries sustained in high risk activities (for example, bungee jumping). But the plan could not exclude an individual from enrollment for coverage because the individual participated in bungee jumping.
Related Questions
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- Can a plan deny benefits otherwise provided for the treatment of an injury based on the source of that injury?
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