Massachusetts Health & Accident Insurance Practice Exam

Which provision requires that the cause of injury be unexpected or accidental?

1. Accidental Bodily Injury Provision

2. Accidental Means Provision

3. Change of Occupation Provision

4. Recurrent Disability Provision

The correct answer is: Accidental Means Provision

The concept of the Accidental Means Provision is essential in insurance policies as it stipulates that for a claim to be valid, the cause of the injury must be both unexpected and accidental. This means that if an individual sustains an injury through a means that was not intended or foreseen, then the provision applies, allowing access to benefits. This provision is crucial in defining the scope of coverage in health and accident policies, as it limits claims to those situations where the injury was not merely foreseeable. This helps to protect insurers from having to pay out on claims that arise from normal or expected activities. In contrast, other provisions such as the Change of Occupation Provision pertain to modifications in the nature of the work being done by the insured, while the Recurrent Disability Provision deals with the circumstances under which a disability may reappear after a recovery. These do not directly address the nature of how the injury occurred in relation to being unexpected or accidental. Thus, the Accidental Means Provision is the one that specifically emphasizes the requirement for the cause of injury to be unforeseen and accidental, reinforcing the principle of unexpectedness in risk management.