If I freeze my legs, like I get trapped outside in the snow, and I need to get amputation, then yea that's covered. But not if I freeze my legs so they get amputated to satisfy some weird fetish. He lied and claimed it was medically necessary and justified it by hurting himself. That is fraud. The insurance company is in the right to try to get the money back. It's like setting your house on fire to collect the insurance. Yes your policy covers a loss in case of fire, but not if you start the fire.