ACCIDENT INSURANCE PLAN - Exclusions
We will not pay benefits for any loss or Injury that is caused by or results from:
- intentionally self-inflicted injury; suicide or attempted suicide.
- war or any act of war, whether declared or not.
- a Covered Accident that occurs while a Covered Person is on active duty service in the military, naval or air force of any country or international organization. Upon receipt of proof of service, we will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days.
- piloting or serving as a crewmember in any aircraft (except as provided by the Policy).
- commission of, or attempt to commit, a felony.
- sickness, disease, bodily or mental infirmity, bacterial or viral infection, or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
- medical expenses and disability for which the Covered Person is entitled to benefits under any Worker's Compensation Act.
- injuries or loss that happens while the Covered Person is legally intoxicated (as determined by that state's laws) or while under the influence of any drug unless administered under the advice and consent of a physician.
- Any expense paid or payable by any other valid and collectible group insurance plan.
In addition to the exclusions above, we will not pay Accident Medical Expense Benefits for any loss, treatment or services resulting from or contributed to by:
- treatment by persons you employ or retain, or by any immediate family member or member of the Covered Person’s household.
- treatment of sickness, disease or infections except pyogenic infections or bacterial infections that result from the accidental ingestion of contaminated substances.
- treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis, osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness, hernia, detached retina unless caused by an Injury, or mental disorder or psychological or psychiatric care or treatment (except as provided in the Policy), whether or not caused by a covered accident.
- pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions.
- Mental and Nervous Disorders (except as provided in the Policy).
- damage to or loss of dentures or bridges, or damage to existing orthodontic equipment (except as specifically covered by the Policy).
- expenses incurred for treatment of temporomandibular or craniomandibular joint dysfunction and associated myofacial pain (except as provided by the Policy).
- injury covered by Workers’ Compensation, Employer’s Liability Laws or similar occupational benefits or while engaging in activity for monetary gain from sources other than you.
- injury or loss contributed to by the use of drugs unless administered by a doctor.
- cosmetic surgery, except for reconstructive surgery needed as the result of an injury.
- any elective treatment, surgery, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States.
- eyeglasses or contact lenses (except as provided in the Policy); hearing aids, wheelchairs, braces, appliances, examinations or prescriptions for them, or repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices.
- expenses payable by any automobile insurance Policy without regard to fault. (This exclusion does not apply in any state where prohibited).
- conditions that are not caused by a covered accident.
- participation in any activity or hazard not specifically covered by the Policy.
- any treatment, service or supply not specifically covered by the Policy.
This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.
Accident and Liability insurance policies are provided by ACE American Insurance Company, Philadelphia, PA, or, in some states, other insurance companies of the ACE Group. Where coverage is provided by a surplus lines insurer that is part of the ACE Group, it is sold only through licensed surplus lines producers. Coverage may not be available in all states. View the Privacy Notice for ACE American Insurance Company.