If a policyholder is injured during a carjacking, how will their Major Medical insurer most likely respond to their claim?

In the context of a major medical insurance policy, the claim related to an injury sustained during a carjacking is likely to be denied due to the nature of the event. Many insurance policies have specific exclusions regarding injuries resulting from acts of violence or crimes. If the carjacking is classified as an assault or criminal act, the insurer may consider it to fall under those exclusions, thus nullifying coverage for medical expenses incurred as a result of the injuries sustained during that incident.

This aligns with a common provision in health insurance policies where coverage is contingent on the circumstances surrounding an injury. Typically, insurers aim to limit their liability for injuries that occur in unlawful settings or due to the individual's engagement in criminal activities.

While there may be situations where a claim could be expedited due to the serious nature of the incident, or approved if the policy terms allow for it, the prevailing stance for this type of scenario aligns with denial based on exclusions for injuries arising from criminal acts. Additionally, partial payment might occur under circumstances where specific injuries or aspects of the incident do not fall under exclusions, but in a carjacking context, denials are more frequently the outcome.