If you insure yourself and break your arm, how can the insurance company prove that the fracture is intentional?

If you insure yourself and break your arm, how can the insurance company prove that the fracture is intentional?

Sports and Torts: Ken Reed, Sports Policy Director for the League of Fans.

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answers (3)

Answer 1
March, 2021

It will be quite difficult to prove that you did this. But, let's calculate how much you owe for such torment and what you have to go through.

It is not so easy to break your hand with seeming prosaicity. What will you do for this? Will you fall from your height onto her? Jump from the second floor onto it? Can you clamp it in a vise and drop something heavy from above perpendicularly? You understand, there is a fine line here that when you try to break your arm, you will inadvertently break something else, and it’s good if it’s just a leg, not a head. And in the most unenviable case, you can break your arm not with a closed, but with an open fracture and you can fly into really expensive treatment, and complications with blood poisoning. And in general, if you did not break your arms and legs, then I can authoritatively declare to you that this is horror how painful it is! So hit gently, but hard.

Let's calculate how much you will be paid for a broken hand. You don't have to go far for numbers: I myself am insured against accidents, this product compensates for a broken arm. So, the policy cost me 1,500 rubles, the maximum amount of coverage is 300,000 rubles. For understanding - this amount is paid only in case of permanent loss of working capacity or death. And in order to find out how much I will be paid for a broken arm, I open the accident insurance rules of the company in which I am insured and find a table that indicates the percentage compensation by type of injury from the maximum amount. Do you know how much I see? 10% maximum! For a broken shoulder! 30,000 rubles for level 80 pain, which then requires expensive treatment and long rehabilitation. Some measly 15,000 rubles are paid for a fracture of the radius! 3 weeks of incomplete working capacity for 15,000 rubles - no, thanks!

I think that the above arguments are enough to understand that if you are not an unemployed gopnik from the song "Noggano - Insure Brother!" you will find easier and more painless ways to make that kind of money. :)

Answer 2
March, 2021

Most likely, the insurance company will not prove something, it will simply refer to some ambiguous clause of the insurance contract, indicating that the case is not insurance and will refuse to pay insurance. Then the ball is on your field - go to court and prove that the reason for the refusal is illegal - you will receive payments, do not apply - you will be left without them.

If in court the insurance company claims that you have caused damage to yourself deliberately - at her request, a forensic medical examination may be appointed, which, taking into account the circumstances of the injury described by you, its nature, pictures, etc., will provide its conclusions. If the CME gives a conclusion that you intentionally inflicted damage on yourself - the court, or the insurance company may turn to law enforcement agencies to prosecute you for fraud (although this is a unlikely forecast, they are usually satisfied with the absence of the need to make payments ) .

Answer 3
March, 2021

The insurance company, no matter what happens, will always do EVERYTHING so as not to pay you.

You will be required to prove, help, confirmation, everything, everything, everything.

В if you harm yourself, it will be extremely difficult to prove that you have nothing to do with it. This means that it will be extremely difficult to get money.

So it's not a question of "how the insurance company will prove", but "how will you prove"

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