Florida’s Drug and Alcohol Exclusion Law
Some insurance policies contain an alcohol exclusion provision excluding from coverage for “any loss incurred as a result of … any injury sustained while under the influence of alcohol or any narcotic unless administered upon the advice of a physician.”
The alcohol or drug exclusion provision is sometimes called the “intoxication exclusion” or the “drunkenness exclusion.”
Drug- and alcohol-exclusion laws allow health-care-insurance companies to include a provision in their policies to exclude coverage for injuries suffered while under the influence of alcohol or impaired by drugs. People taking medications prescribed by a doctor, and taking them as prescribed, are outside the scope of these statutes.
When the insurance policy has that kind of provision, can the purported beneficiary be denied benefits on the basis that the injury occurred because the insured’s alcohol intoxication contributed to his death? Under Florida law, the short answer is “Yes.”
In the 1940s, the model Alcohol Exclusion Law was created as part of the model Uniform Accident and Sickness Policy Provision (UPPL). In 1947, an organization of insurance regulators, the National Association of Insurance Commissioners (NAIC), adopted the model language. Shortly thereafter, a majority of states also adopted the model provision.
The alcohol or intoxication exclusion policy created a number of public policy problems. Because of the problem with insurance claims being denied, the medical community developed policies against testing for or documenting drug or alcohol impairment out of fear that insurance claims would be denied.
As a result of these problems, the NAIC revised the UPPL to remove the model Alcohol Exclusion Law in 2001. Since that time, however, only 14 states plus the District of Columbia have taken action to repeal or amend the statutory authority that authorized drug and alcohol exclusions in health insurance policies.
In Florida, no action has been taken to prohibit drug or alcohol exclusions in health and life insurance policies. As a result, Florida’s alcohol exclusion law permits insurance companies to deny claims associated with the consumption of alcohol or the illegal use of drugs.
This law often comes into play in a DUI crash with personal injuries, serious bodily injury, or death.
Florida Law on Alcohol Exclusion Policies
In Am. Heritage Life Ins. Co. v. Morales, 159 So. 3d 160, 164 (Fla. 3d DCA 2015), the court concluded that an alcohol exclusion or drunkenness exclusion provision would bar recovery of benefits if there is “some” causal relationship between the insured’s intoxication and his death.
In fact, the insured was not even required to prove that alcohol was the sole cause of the death. See Harris, 233 So.2d at 834–35. In Harris, the Florida Supreme Court considered an alcohol exclusion provision in an accidental death policy that provided:
“Death … resulting directly or indirectly, wholly or partially from any of the following causes are risks not assumed under this policy… (c) Bodily injury while under the influence of alcohol or drug….”
233 So.2d at 833–34.
Other cases recognize that the insurer does have the burden to show a relationship between death and the intoxication. In the Harris case, the insured was intoxicated by alcohol while riding as a passenger in an automobile when he was killed in a car crash. Harris, 233 So.2d at 833.
The parties acknowledged that no causal connection existed between the accident and the insured’s intoxication, but the insurer argued that the provision excluded coverage whether or not the insured’s intoxication played any role in his death. Id. at 834. The Court rejected this argument.
First, the Harris Court reasons that if read literally, the exclusion would “deny liability for the accidental death in an automobile collision of a person being transported in an ambulance simply on the ground that the victim of the accident was under sedation at the time.” Id. at 834.
Instead, the Court announced the current rule:
“we hold that an insurer has the burden to show some causal relationship between the death and the intoxication in order for the exclusionary provision to be effective.”
Id. at 834–35 (emphasis added).
In English, a life insurance policy included an alcohol exclusion provision that provided:
“[This] policy does not cover any loss incurred as a result of … Any injury sustained while under the influence of alcohol or any narcotic unless administered upon the advice of a physician.”
786 So.2d at 1281.
After the insured in English was killed in a car accident, his beneficiary brought suit to obtain the life insurance policy’s benefits. The paramedic that arrived on the scene after the crash concluded that the insured fell asleep at the wheel before driving this vehicle into two fixed objects.
“The paramedic noted the distinct smell of alcohol on [the insured’s] breath and a blood-alcohol test result of .189 confirmed that he had been driving while under the influence.” Id. at 1280–81. Although the trial court ruled that the alcohol exclusion provision did not apply, the Fifth District reversed.
The appellate court concluded that the alcohol exclusion provision applied because the insurer met its burden of showing a causal relationship between the insured’s accident and intoxication. Id. at 1282.
Although there was a possibility that fatigue may have caused the insurer to fall asleep at the wheel, the court found that:
“Whether [the insured] fell asleep as a result of fatigue or the effects of alcohol, we believe that [the insurer] carried its Harris burden to show a causal relationship between death and intoxication.” Id. The court distinguished the case from Harris, by concluding that English was the driver of the vehicle and the “instrument that caused the vehicle to crash….”
Id. at 1281.
Drug and Alcohol Exclusions in Health-Insurance Policies and the Courts – In an article on trends in state courts published in 2019, an analyst for the National Center for State Courts compares the way drug and alcohol exclusion clauses are viewed by the courts. The article also explains why alcohol exclusion or drunkenness exclusion provisions are bad public policy since substance abuse is a medical condition and not merely an ethical or character defect.
NHTSA on Alcohol Exclusion Laws – Visit the website of the National Highway Traffic Safety Administration to find an article published in January of 2008. The article explains why the NHTSA encourages states to examine insurance laws for the existence of alcohol exclusions and supports legislation to eliminate barriers to both blood alcohol concentration (BAC) testing and treatment access for those with alcohol use or dependency problems. The article explains why alcohol exclusion laws reduce the incentives for physicians to test BACs of injured people who may have been driving at the time of their injury and may also deter injured drivers from seeking medical treatment.
Florida’s Alcohol and Intoxication Exclusion Law – Visit the website of the Florie Supreme Court to find an initial brief filed by BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. The brief addresses issued related to whether Section 627.629, Florida Statutes, permits a health insurer like Blue Cross and Blue Shield of Florida to include a drunkenness exclusion in its police.
This article was last updated on Friday, September 13, 2019.