Accident

An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.

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Insurance plans may include accident-specific benefits such as accidental dental coverage, accidental death and dismemberment (AD&D) insurance, or fracture benefits. These benefits provide reimbursement or lump-sum payments to help cover medical, dental, or financial costs that result directly from the accident.

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To qualify for coverage, the injury must be directly caused by the accident and not related to illness, self-inflicted harm, or hazardous activity exclusions listed in the policy.

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Example:

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If you slip on ice and break your wrist, the event qualifies as an accident because it was sudden, external, and unintended. Your accident coverage may reimburse related medical or physiotherapy expenses, depending on your plan.

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What to Watch For:

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Check your policy’s definition of an accident, as each insurer sets specific criteria. Some policies exclude injuries from high-risk sports, intoxication, or pre-existing conditions that contributed to the event. Always report the accident and seek medical treatment promptly, as delays can affect eligibility for benefits.