Punching a wall

[jbott59]

What is the name of your state (only U.S. law)? Indiana

Recently my younger sibling, frustrated over an ex-girlfriend, punched a wall and broke a bone in his hand. My family's insurance policy, a self-insured policy through my parents employer, has recently denied the claim under a provision that states something like "whether sane or insane, an intentional act to inflict injury upon one's self is not covered." Is anyone familiar with this type of situation? Also, the minor surgery required for the broken bone became infected and resulted in an additional surgery and a 2 day stay at a local hospital. If the first is excluded, can they also exclude this second surgery and hospital stay resulting in the complications of the first surgery?

[cyjeff]

If the initial treatment wasn't covered, neither will the subsequent treatment.

[jbott59]

Thanks.

Any suggestion on the exclusion. The exclusion seems to address those that want to inflict harm on themselves i.e. those that cut or mutilate themselves in attempts at suicide. This was an act of emotion that was not intended to inflict any harm. Any thoughts?

[Blue Meanie]

Originally Posted by jbott59

Thanks.

Any suggestion on the exclusion. The exclusion seems to address those that want to inflict harm on themselves i.e. those that cut or mutilate themselves in attempts at suicide. This was an act of emotion that was not intended to inflict any harm. Any thoughts?

How old is your brother?

[cyjeff]

Originally Posted by jbott59

Thanks.

Any suggestion on the exclusion. The exclusion seems to address those that want to inflict harm on themselves i.e. those that cut or mutilate themselves in attempts at suicide. This was an act of emotion that was not intended to inflict any harm. Any thoughts?

I think you would have a hard time explaining how hitting a way wouldn't hurt.

You can try to get an attorney and see what he/she says.

[jbott59]

My brother is 17.

[Blue Meanie]

Originally Posted by jbott59

My brother is 17.

Then he is old enough to realize punching a wall will/could cause injury. Tell you mother to make Jr. get a job and pay the bill.

[jbott59]

Originally Posted by cyjeff

I think you would have a hard time explaining how hitting a way wouldn't hurt.

The point is that hitting the wall was an act of frustration and the intent was not to inflict harm on one's self. Yes if he repeatedly hit the wall until he broke a bone than fine I could see your point. But hitting the wall once is a common thing that young adolescence do. I could see cutting or burning one’s self as an intent to inflict harm, not hitting someone or something.

[Blue Meanie]

Originally Posted by jbott59

The point is that hitting the wall was an act of frustration and the intent was not to inflict harm on one's self. Yes if he repeatedly hit the wall until he broke a bone than fine I could see your point. But hitting the wall once is a common thing that young adolescence do. I could see cutting or burning one’s self as an intent to inflict harm, not hitting someone or something.

I never did...My child never did...None of my family hit walls in frustration. It is not a normal thing to do.

[momm2500]

this is mainly geared towards suicide. how did they know that he punched the wall? did someone tell the insurance company? i would appeal the denial!

[lealea1005]

Originally Posted by momm2500

this is mainly geared towards suicide. how did they know that he punched the wall? did someone tell the insurance company? i would appeal the denial!

A couple of ways:

Documented under "chief complaint" in his medical record. OR....

Beacuse it was an "injury", when the insurance company received the claim, they contacted the Physician's office or ER for the complete treatment notes AND/OR the patient for a written statement.

A patient of ours recently had a claim denied under the "intentional act" explanation because three 14 year old knuckleheads decided it may be fun to see what happens after running, full speed, into a brick wall. The insurance company for one of the bright young men denied the initial ER claim, and also our claim for the suture removal from his head laceration.

[VeronicaLodge]

Originally Posted by baystategirl

I never did...My child never did...None of my family hit walls in frustration. It is not a normal thing to do.

i never have and no one in my family has either.

[xylene]

Use a stud finder first.

This is a true story.

I watched my dad, momentarily temper his fit of rage, pause to check the wall with a stud finder before punching a hole clean through from the kitchen to the den.

Gloves are a good idea too.

[seniorjudge]

Originally Posted by jbott59

...
The point is that hitting the wall was an act of frustration and the intent was not to inflict harm on one's self.
...

And I repeat: You intend the natural and probable consequences of your own actions.

[Silverplum]

Originally Posted by seniorjudge

And I repeat: You intend the natural and probable consequences of your own actions.

Your reason and logic are so attractive.