World · East Asia & Pacific · 19 mins ago
Court rejects insurance claim over wrist fracture after car exit
A person identified as A was diagnosed with a fractured right wrist after saying they fell while getting out of a stopped car in November 2022.
A’s medical records described the fall, but the account came from A rather than a medical worker who witnessed it.
A filed the insurance claim about nine months later under an add-on to their car insurance.
The insurer argued there was not enough evidence to show the injury resulted from the vehicle’s use, and the court agreed.
The records did not establish whether A was driving or riding as a passenger, or exactly when and how the fall happened; A provided no CCTV or dashcam footage.
The court also noted that A worked for an insurance claims firm and said the late notice made it harder to check the incident.
The ruling means the insurer did not have to pay; the case highlights that people claiming insurance must prove the accident happened as they say.
A court rejected an insurance claim by a person who said they fractured their wrist while getting out of a car.
The court said the medical records repeated the claimant’s account but did not establish how the injury happened.
The claimant had no CCTV or dashcam footage or other evidence beyond the medical records.
The accident was reported to the insurer about nine months after it happened, making it harder to check the circumstances.
The court noted that the claimant worked for an insurance loss-adjustment company and should have understood the need for objective evidence.
- Who
- A claimant identified as A, who worked for a life insurer’s loss-adjustment company.
- What
- A court rejected A’s claim for insurance benefits over a right wrist fracture.
- When
- A was diagnosed in November 2022 and reported the accident about nine months later, in August 2023.
- Where
- Not stated.
- Why
- The court found that the medical records alone did not prove the accident’s circumstances or that it was covered by the policy.
The insurer
A
Coverage
The insurer
The insurer argued the fracture was not proven to have resulted from vehicle operation.
A
A sought benefits under the car insurance’s automobile injury coverage.
Evidence
The insurer
The insurer said the claimant had not established the required circumstances of the accident.
A
A relied on hospital records describing an injury while getting out of a stopped car.
A was diagnosed in an emergency room with a fracture near the right wrist.
A reported the accident to the insurer in August 2023.
The insurer filed a lawsuit seeking confirmation that it had no obligation to pay, and A counterclaimed for benefits.
The court ruled for the insurer, finding the accident circumstances were not established.
- Injury
- Fracture near the right wrist
- Diagnosis
- November 2022
- Accident report
- August 2023, about nine months after the accident
- Evidence described
- Hospital records; no CCTV or dashcam footage was submitted
- Claimant’s job
- Worked for a life insurer’s loss-adjustment company
What people are saying
The principle that the person claiming insurance benefits must prove the accident applies equally regardless of occupation
The more a person is considered to know about insurance, the more disadvantageous it can be not to prepare supporting evidence