Question

Phil heads over to visit his friend Josh, who is sick with the flu. While at the house, Josh fails to cover his mouth when he coughs and Phil ends up contacting the flu. Phil files a claim with Josh's insurer for medical expenses and lost income while Phil is out sick from work. The insurer denies the claim because:

a) Phil didn't provide sufficient medical documentation.
b) Phil's illness was not caused by Josh's actions.
c) Phil failed to submit the claim within the specified time frame.
d) Phil's insurance coverage doesn't include flu-related expenses.

Answer 1

Phil's claim to Josh's insurer for catching the flu was denied, likely because flu transmission does not usually establish legal liability. Also, insurance policies typically don't cover transmissible diseases through general interaction, and coverage may depend on the specific terms and timely claims process.

Step-by-step explanation:

When Phil files a claim with Josh's insurer after catching the flu from Josh, the insurer's rejection could potentially be for several reasons. However, infectious diseases like the flu are typically transmitted by contact with respiratory secretions from an infected person, and although Josh's coughing without covering his mouth is negligent, it generally does not constitute a legally actionable cause for Phil to claim medical expenses and lost income. Insurance policies normally do not cover such transmissible illnesses unless specific liability can be proven. Moreover, timely claim submission and sufficient medical documentation are crucial to enable insurers to process claims. It is also necessary for the individual's own insurance coverage to include such expenses. Evaluating the denial can focus on the causal link between Josh's actions and Phil's illness, which in this case, is unlikely to be seen as directly causing the flu.