What Does MetLife Accident Insurance Cover?

MetLife accident insurance covers more than 150 injury and treatment events tied to an accidental injury, paying a fixed cash benefit for each one directly to you. Covered events fall into a few groups: specific injuries (fractures, dislocations, burns, concussions, lacerations, eye trauma), emergency and follow-up care (ambulance, ER visits, imaging, therapy, medical appliances), hospital admission and confinement, a defined list of surgeries, and catastrophic outcomes like accidental death, dismemberment, and paralysis. Because the money is paid to you rather than to a provider, it can go toward deductibles and copays or toward rent, groceries, or anything else you need during recovery.¹

The key word is accident. Illness, disease, and pre-existing conditions fall outside the policy entirely, no matter how expensive the treatment. Everything else in this article assumes an accidental injury triggered the claim.

Injuries on the Benefit Schedule

Each covered injury has a set dollar amount attached, and many of them scale by severity. A chip fracture pays 25% of the full fracture benefit; a complete break pays the full amount. Dislocations work the same way, with partial dislocations paying 25% of a full one.¹

Fractures, with amounts that depend on which bone and whether the break is partial or complete. In a typical high plan, fracture benefits range from about $100 for a minor bone to $6,000 for a major one.
Dislocations, full or partial.
Second- and third-degree burns, with payouts scaling by severity and the percentage of body surface affected.
Concussions, paid as a flat amount per diagnosis (around $400 in a typical high plan).
Lacerations requiring stitches or surgical closure, with the amount tied to length or severity.
Eye injuries requiring medical treatment.

Exact dollar amounts depend on the plan tier your employer selected. Low plans generally pay about half what high plans pay for the same injury.

If one accident causes several covered injuries, the policy can pay for each qualifying item from that incident rather than capping you at a single event.

Hospital Admission and Confinement

Two separate hospital benefits kick in when an accident lands you in a bed. An admission benefit pays a one-time lump sum when you’re first admitted. A confinement benefit then pays a daily amount for each day of your stay, with ICU days paying a higher rate than a standard room.¹

One useful detail: MetLife’s definition of confinement includes time in an observation area, as long as it lasts at least 20 continuous hours. Hospitals often place patients under observation status instead of formally admitting them, which can raise your out-of-pocket costs under regular health insurance. The accident policy’s confinement benefit can still pay in that situation. Some plans add an inpatient rehabilitation benefit that pays a daily amount for post-accident rehab stays.

Surgeries the Policy Pays For

The surgery benefit covers a specific list rather than every operation. Procedures typically named in the certificate include cranial surgery, skin grafts for covered burns, hernia repair, thoracic and abdominal cavity surgery, ruptured disc repair, torn knee cartilage (meniscus) surgery, and repair of torn tendons, ligaments, or rotator cuffs.²

Payouts vary by procedure. A hernia repair or exploratory surgery might pay $200, torn knee cartilage surgery around $1,500, and thoracic or abdominal cavity surgery about $2,000. When one accident requires multiple surgeries performed at the same time, the policy pays only for the single surgery with the highest benefit amount. The surgery benefit is limited to one payment per accident.²

Epidural anesthesia for pain management is a separate benefit, typically around $100. General anesthesia related to a covered surgery does not appear as a standalone line item in most plan summaries, so it is likely bundled into the surgical benefit rather than paid separately.

Emergency and Follow-Up Care

Recovery from an accident rarely stops at the ER. The benefit schedule covers a range of follow-up services, each paying a fixed amount per visit and most capped at a certain number of visits per accident.

Ambulance transportation, with ground ambulance benefits typically around $200–$300 and air ambulance around $750–$1,000 depending on plan tier.¹
Emergency room care and separate benefits for non-emergency urgent care or physician office visits.
Physician follow-up visits, at a fixed amount per visit and often limited to a set number of visits per accident.
Therapy services: physical therapy, chiropractic care, occupational therapy, speech therapy, cognitive behavioral therapy, and acupuncture. Plans typically cap sessions per accident, and per-session amounts are modest, often $15–$25.
Diagnostic imaging, with MRIs, CT scans, ultrasounds, and X-rays each carrying their own benefit. Advanced imaging pays more than plain X-rays.
Medical appliances like crutches, braces, and wheelchairs needed after an accident.

The therapy amounts won’t cover the full cost of a physical therapy visit, but they help offset the copays and coinsurance your health plan charges.

Accidental Death, Dismemberment, and Paralysis

If a covered accident causes death, the policy pays an accidental death benefit to your beneficiaries. A typical high plan offers around $50,000, with a higher amount (roughly $150,000) if the death occurs while you’re a passenger on a common carrier such as a commercial airline or train.

Dismemberment and loss benefits cover permanent impairments from an accident, including loss of a hand, foot, or eye and loss of speech or hearing. Paralysis benefits cover paraplegia and quadriplegia. Payouts scale with severity. Dependent coverage generally pays a reduced percentage of the employee’s benefit amount.¹

Extras Worth Knowing About

A few smaller benefits often go overlooked at enrollment but matter later.

Lodging benefit. If you or a family member has to travel at least 50 miles from home for specialized treatment while hospitalized, the policy pays a nightly amount for a companion’s lodging, often up to 30 nights per year. This benefit isn’t available in every state.¹
Wellness or health screening benefit. Some plans pay a small annual amount (roughly $50–$100) for completing a qualifying preventive screening, whether or not you’ve had an accident.
Organized sports activity rider. Some plans increase benefit payments by 25% for injuries sustained in an organized sport. Whether your plan includes this rider or instead excludes sports injuries depends on the specific policy your employer chose.

What the Policy Does Not Cover

The policy only pays for accidental injuries. Illness, disease, and any condition not triggered by an accident sit outside coverage. That includes infections (unless they entered through an accidental wound), pregnancy, and any treatment tied to a pre-existing medical condition. A shoulder that was already deteriorating before an accident can lead to a denied or disputed claim on that shoulder.

MetLife certificates also list explicit exclusions. The exact list varies by plan, but common ones include:

Self-inflicted injuries, including suicide attempts
Injuries sustained while committing a felony
Injuries caused by intoxication or non-prescribed drug use
War, insurrection, or military service
Aviation activities other than flying as a fare-paying passenger on a commercial airline
Injuries sustained while incarcerated

Sports participation is where plans diverge the most. Some policies exclude injuries from professional or amateur sports entirely, while others include the organized sports rider that boosts your payout. If you play in a recreational league or compete in any organized sport, read your certificate closely. This is the most common source of surprise denials for physically active policyholders.

How It Fits With Other Coverage

Accident insurance is supplemental. It pays on top of your regular health insurance and does not replace it. Payments come to you regardless of what your health plan covers or how you spend the money.

Two related MetLife products cover different situations. Hospital indemnity insurance pays when you’re hospitalized for any reason, including planned surgeries and illness, and it’s sold separately. Critical illness insurance pays a lump sum for diagnoses like cancer or heart attack, whether or not an accident caused them.³

Accident insurance is also separate from workers’ compensation. If you’re injured on the job and receive workers’ comp, the accident policy can still pay its scheduled amounts; the certificate explicitly states it is not a workers’ compensation policy.²

1
MetLife. Accident Insurance
2
Metropolitan Life Insurance Company. Certificate of Accident Insurance
3
MetLife. Critical Illness Insurance vs. Hospital Indemnity vs. Accident vs. Disability