The movie opens in a similar fashion to the earlier films - a woman (played by Tanedra Howard, winner of the 'Scream Queens' reality show) awakens in a dark room with a trap on her head. The trap consists of a headset with two bolts placed at her temples in such a position that they will drill into her brain if activated. Across the room, separated from the girl's location by an impassable fence, an overweight man awakens with the same device on his head. Despite the girl's efforts to control the situation, the man panics, and accidentally activates the signature television message from Jigsaw. Jigsaw blames the two individuals for their roles in medical insurance 'crimes' (denying policies and claims for profit) and directs their attention to a scale mounted between the fences. One of the two will most certainly die, according to Jigsaw, and the survivor will be the one who cuts off the most flesh from their own bodies and places it on the scale in a 60 second time frame. To demonstrate what will happen if they are unsuccessful, Jigsaw gives a warning twist of the screw headsets, causing them minor injuries. When the tape stops, the man takes a knife from a table of tools left by Jigsaw and begins to cut away at his love handles for the scale. The girl is physically fit and has no such option, and first attempts to cut her chains. However, the man has already cut away a portion of his flesh and dropped it into the scale, and has started on a second. The girl panics and ties surgical tubing around her upper arm to form a makeshift tourniquet, and starts to cut her arm off with the knife. By the time she has done this, however, the man has placed a second hunk of flesh on the scale. With seconds left to spare, the girl grabs a butcher knife and brutally hacks away at her entire arm, severs it, and drops it into the scale. This swings the weight on her favor and the man dies as the headset drills into his brain. The girl survives, ending the opening scene.