(Period Covered: 1/1/1998 through 1/1/2009)

Policy Description

In 1950, the National Association of Insurance Commissioners (NAIC) developed a model law entitled the Uniform Accident and Sickness Policy Provision Law (UPPL).  If enacted by States, it would permit insurers to include a provision in insurance policies that reads as follows:

The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician [1].

In most cases, jurisdictions with provisions reflecting this model law (also termed insurance exclusion) use this identical wording.

In contrast, in some jurisdictions, statutes and/or regulations explicitly prohibit insurers from denying payment for insurance benefits for losses due to the intoxication of the insured.  For example, South Dakota's statute prohibits insurers from denying health/sickness insurance benefits for injuries sustained while under the influence of alcohol or drugs. 

Most State statutes and regulations that either permit or prohibit this form of exclusion apply to health (sometimes called sickness) insurance. Laws in some jurisdictions also apply to accident, long-term care, disability, and/or life insurance. 

Almost all States that have explicit policies regarding exclusion of claims arising from intoxication apply those rules to health insurance. The coding displayed in the APIS comparison tables for this policy topic is limited to health insurance. Notes are provided for the few States with provisions that apply to accident insurance but not health insurance. 

Similar State policies for motor vehicle coverage are addressed in the APIS policy topic on Vehicular Insurance Exclusion.

To view the comparison tables and additional
information about this policy topic, click
on the links on the right side of this page.

Email a link to this page: http://alcoholpolicy.niaaa.nih.gov/ILLDIandUPPL