We therefore sought to determine the legal ability of insurance carriers to deny coverage for the trauma care of a patient who was intoxicated at the time of injury. We first sought to obtain data from the insurance commissioners in all 50 states. The majority of the respondents claimed that if the insurance contract, agreed to by the patient, contained a specific exclusion for injuries due to intoxication, the insurer can legally deny coverage for the care. Prompted by the similar wording of the exclusions referenced in the survey of insurance commissioners, we examined the relevant statutes governing insurance in all 50 states, as well as contacted the National Association of Insurance Commissioners. This revealed that the exclusion of coverage for injuries involving alcohol was based on a model law, the Uniform Accident and Sickness Policy Provision Law, promulgated by the National Association some four decades ago.
Similar provisions allow for the exclusion of coverage for acute medical care of suicide attempts.
Two states, Minnesota and Oklahoma, allow insurers to deny coverage only if the insured is under the influence of narcotics, not alcohol, at the time of injury. New York and South Dakota only allow the insurer to deny the claim if the injury is sustained while the insured is in the act of committing a felony. Statutes concerning insurance policies in the remaining eight states are silent on the issue of denial of coverage. That is, by drinking alcohol, people knowingly put themselves in harm s way. In their view, denying a claim based on the provision that the carrier is not liable for coverage of injuries sustained under the influence of alcohol is similar to denying coverage for self-inflicted injuries in a suicide attempt.