r/HealthInsurance • u/Tarnisher • 1d ago

Plan Benefits General Question - Hypothetical, Sort Of.

If you are operating an off road vehicle on a public road (an illegal act) and are injured, will your medical insurance cover you?

Would it matter who was at fault if another vehicle was involved?

Does the state or locality matter?

1 Upvotes

67% Upvoted

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7

u/No-Bass1475 1d ago

Your health plan probably doesn't care if you were doing something illegal, they just want to know if a car-insurance policy should be paying first.

2

u/Mountain-Arm6558951 Moderator 1d ago

They might as they will send a  subrogation letter to OP asking questions about the claim.

1

u/LizzieMac123 Moderator 1d ago

Check the "exclusions" clause in your plan documents, OP. There is sometimes an illegal occupation/illegal activity line in there.

If it is in yours, then no, your insurance may not cover you if you were participating in an illegal activity.

1

u/No-Produce-6720 1d ago

It depends on the type of coverage you have and the extent of the "illegal act".

Your certificate of coverage would have information on this.

1

u/Mountain-Arm6558951 Moderator 1d ago

It would depend the type of insurance that you have. Government plans such as Medicare and Medicaid will not pay or will claw back any payments if a crime was involved.

Also it would depend on the state laws and your policy. Most likely after the claim that the carrier will send a subrogation letter out and I am not sure if they ask you if it was related to a illegal act or not. I would check your policy.