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Life and Health


By February 1, 2013No Comments

Let’s say you have a beer or one cocktail at a party, trip over the carpet, and wind up in the emergency room with a broken ankle. Now imagine the shock of finding out later that your Health insurer is denying your claim due to the presence of alcohol in your system.

Insurance claim denials for alcohol use are based on the 1947 National Association of Insurance Commissioners (NAIC) model law, which says that insurers should be allowed to deny claims for patients if they are injured while under the influence of alcohol. In 2001, the NAIC changed its recommendation and encouraged states and Health insurance companies to provide coverage for patients regardless of alcohol use. As a result, a number of states repealed or amended their laws. Today, any state can choose to either authorize or prohibit insurance exclusions for alcohol use, from one drink to actual intoxication.

Insurance companies follow their own policies, as well as state regulations, when making a determination about alcohol related claims. Some health carriers explicitly exclude paying claims that involve any use of alcohol. Many other insurance companies, however, will provide coverage regardless of alcohol consumption by the claimant.

To find out how your claim will be treated if you have a medical emergency after drinking, feel free to get in touch with us.