Which reason would the CGL insurer use for denying Austin's Coverage C claim?

Which reason would the CGL insurer use for denying Austin's Coverage C claim?

• A. The accident happened more than a year ago
• B. He is entitled to workers compensation benefits
• C. The patient did not sign a consent form
• D. The hospital bill is excessive

Answer: (B)

Coverage C in a CGL policy pays medical expenses for third parties injured on the insured’s premises or by the insured’s operations, regardless of fault, but not when workers’ compensation applies. If Austin is entitled to workers’ compensation benefits for the injury, those benefits provide the exclusive remedy for a work-related injury, so the CGL medical payments would not apply. That’s why the insurer would deny Coverage C in this situation. The other reasons—timing of the accident, lack of a consent form, or a bill being excessive—don’t determine eligibility under Coverage C in the same way that workers’ comp does.

Coverage C in a CGL policy pays medical expenses for third parties injured on the insured’s premises or by the insured’s operations, regardless of fault, but not when workers’ compensation applies. If Austin is entitled to workers’ compensation benefits for the injury, those benefits provide the exclusive remedy for a work-related injury, so the CGL medical payments would not apply. That’s why the insurer would deny Coverage C in this situation. The other reasons—timing of the accident, lack of a consent form, or a bill being excessive—don’t determine eligibility under Coverage C in the same way that workers’ comp does.