Could supplemental accident insurance cover a serious adverse reaction to prescribed medication?

Long story short: my spouse recently had to go to the ER and subsequently spent a few days in the hospital and missed about two weeks of work due to severe nausea/vomiting caused by medication taken as prescribed by their doctor. Specifically, this occurred after taking the second dose following an increase in the dosage.

I have supplemental accident insurance through Aetna (in addition to an HDHP which is covering most of the costs associated with this incident), and I'm trying to parse through the wording of what is covered and not in order to determine if it's worth filing a claim. In general, I think the coverage is obviously more intended for things like broken bones, etc., but I could also potentially see an argument to be made for this situation. Here are some definitions provided in the plan document:

Accident
A sudden, unexpected event, which occurs on or after the effective date of coverage for the covered person and while this certificate is in force, that is the direct cause of an accidental injury to a covered person.

This was certainly a sudden and unexpected event, the plan has been in effect since the start of the year, and they are a covered person. So the question then is, would this be considered an "accidental injury"?

Accidental injury
An injury to a covered person that is directly caused by an accident and is the direct cause of an injury or loss sustained on or after the covered person’s effective date of coverage and while this certificate is in force, which is independent of sickness and not excluded under the policy.

Ok, a bit of circular definition here — an accident is the direct cause of an accidental injury, which is defined as an injury caused by an accident? The term "Injury" itself is not defined anywhere, and that may be the definition that this coverage depends on.

Sickness
A disease, bodily infirmity, illness, infection or any other physical condition that affects the covered person and is wholly independent of an accident.

Well, the sickness was caused by the medication, so it's definitely not "wholly independent".
Under exclusions, this is the only one that would even be tangentially related to this situation:

Substance abuse and use
Any accidental injury sustained while you were:
– Legally intoxicated or under the influence of alcohol as defined by the jurisdiction in which the accidental injury occurred
– Under the influence of a stimulant, depressant, hallucinogen, narcotic or any other drug intoxicant, including those prescribed by a physician that are misused by you.

Alcohol was not involved, nor was any drug except those taken exactly as prescribed by a physician, so this could not be excluded on the basis of substance use/abuse.

I'd appreciate any thoughts on this as well as any guidance for other things to look for in the plan documents to try and get clarification. I'm leaning towards "no, it wouldn't be covered", but I also feel like there's enough here to make me question that. I mainly have this plan because 1. it's cheap, especially after taking advantage of the preventive care benefits it provides and 2. I'm fairly active and have a mildly increased risk of accident just due to that, so I figured it wouldn't hurt to have the extra coverage.

submitted by /u/AgentMonkey
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