Most claims filed with health insurance companies involve accidents, where individuals are harmed through no fault of any individual party. Occasionally, though, a person will be injured through the intentional action of another person. Most "deliberate injury" cases occur in the context of the workplace, where employers can be held liable for their role in inflicting harm on an individual. However, there are other cases, such as with minors, where deliberate injury occurs. In these instances, questions abound about the responsibility of insurance providers to pay out the claim.
When a minor is injured through the deliberate act of another, insurance companies still have a responsibility to pay the claim in most instances. Whether the action was intentional or accidental, the injured person still has a right to the insurance coverage that they have purchased. One exception may be when the injured minor himself was a part of the planning of the deliberate injury. In this instance, filing an insurance claim could constitute a form of fraud, which would discharge the responsibility of the insurance provider to pay out the claim. In most typical instances, though, the insurance provider will be responsible for paying out the claim even when the injuries occurred because of intentional action.
Insurance companies may have the ability to file a lawsuit against the party that committed the deliberate action. In these instances, the insurance company would be seeking to re-coup its losses as a result of intentional or deliberate behavior on the part of a minor or the minor's family. Even if the insurance company happened to be successful in this type of lawsuit, it would still have a responsibility to pay the claim filed by the injured person because of the contractual relationship existing between the injured person and the insurance provider.