Plain version: health and disability policies first ask what caused the loss. Was it an accident or a sickness? The answer can change what a policy pays. For example, a disability policy might pay for up to five years after an accident but only two years after a sickness.
California's definition of disability insurance (Ins. Code §106(a)) separates losses caused by accidents from disablement caused by sickness.
Accident: a sudden, unforeseen event, such as a fall, a fire or a car collision.
Sickness: an illness that develops in the body, such as pneumonia or an infection.
Accident coverage defines a covered accident in one of two ways:
Accidental means: both the cause and the result must be unexpected. If the act itself was intended, there is no coverage, even if the injury was a surprise.
Accidental bodily injury (also called accidental results): only the result must be unexpected. An intended act that leads to an unexpected injury is covered.
Example: Lena swings a golf club the way she always does and tears a shoulder muscle. The swing was on purpose; only the injury was unexpected. An accidental bodily injury policy pays; an accidental means policy does not. That is why accidental bodily injury is the broader wording and the better one for the insured.