Man Denied Health Insurance Benefits For Injuries Incurred During Rescue

You might have seen or heard about this story yesterday: a man saved a woman and her grandchildren from a fire, then went to the hospital to get treated for smoke inhalation.  The insurer apparently denied him benefits because they said his injuries were intentionally incurred.  Many health insurance policies do include exclusions for self-inflicted injuries, which usually means suicide attempts.  A typical phrasing of this clause is like this: "no benefit is payable for expense for or in connection with . . . intentionally self-inflicted injury while sane or insane."

Note that the exclusion requires not just intentional conduct, but intentional self-infliction of injury.  Otherwise heart attacks wouldn’t be covered after a lifetime of intentionally eating kettle chips.  The chips are intended, the heart attack is not.  Let’s look at the man’s actions in that light.  Does running into a burning building and inhaling smoke while rescuing three people constitute a self-inflicted injury?  Come on, was the man’s purpose in going into the building to inhale smoke or was it to save children? If he could have gone in and saved children without inhaling smoke, wouldn’t he have done it? Or are we to believe he would have let the people perish unless it was certain he could inhale smoke? If he wanted to self-inflict smoke injuries, wouldn’t he have just set his own house on fire and inhaled deeply, or started a camp fire with green wood and stood downwind? Would they also deny him benefits if he had a respiratory illness due to smoking cigarettes?


Filed under First Party Insurance

3 Responses to Man Denied Health Insurance Benefits For Injuries Incurred During Rescue

  1. Henry S. Queener

    This story occurred in TN.
    Being a TN attorney I would love to know the ins. co. just in case thats my ins. co.

  2. Seth Chandler

    If I were a Tennessee lawyer, I would love to know the insurance company so I could sue them for bad faith. Maybe there is more to the story, but if the journalist’s account is correct, that is truly an indefensible interpretation of a policy. And if I were the insurance company’s GC or CEO, I’d be finding the fastest way I could to undo the claims decision and throw some money at a hero before a jury did it for me. Indeed, if I were a large insurer in Tennessee who did NOT insure these folks, I’d consider (somewhat seriously) shaming the insurer involved and preventing the growth of costly insurers-are-devils fervor by paying the claim myself or by passing the hat among responsible insurers.

  3. I’d like to think this was just some loose cannon employee who didn’t know what they’re talking about rather than a company policy. But in the long run, it doesn’t matter, a company is what its agents do. It would be a fun case to plaintiff, you just can’t get any more wrong than this decision, and you can’t look any worse than denying benefits to a man who saved kids from a fire.