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[SloJon]

The insurance lobby cares...right?...


Insurers' Liability for Losses Due to Intoxication ("UPPL")

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.

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.

http://www.alcoholpolicy.niaaa.nih.gov/index.asp?Type=BAS_APIS&SEC=%7B7AC19035-9A30-41E2-8C51-D33EC71A6798%7D

In states where UPPL is in force ER doctors can't voluntarily check an injured driver's blood for alcohol or drugs.

WHY?

Simple...If the driver tests positive for either the hospital won't be paid for services rendered.

Google 'uppl states' for an education. Here's a sample:


The Implications of Alcohol Intoxication and the Uniform Policy Provision Law on Trauma Centers; A National Trauma Data Bank Analysis of Minimally Injured Patients.

Original Articles
Journal of Trauma-Injury Infection & Critical Care. 66(2):495-498, February 2009.
O'Keeffe, Terence MB, ChB, MSPH; Shafi, Shahid MD, MPH; Sperry, Jason L. MD, MPH; Gentilello, Larry M. MD, FACS

Abstract:
Background: Alcohol intoxication may confound the initial assessment of trauma patients, resulting in increased use of diagnostic and therapeutic procedures, thereby increasing hospital costs. The Uniform Policy Provision Law (UPPL) exists in many states and allows insurance companies to deny payment for medical treatment for alcohol-related injuries. If intoxication increases resource utilization, these denials compound the financial burden of alcohol use on trauma centers. We hypothesized that patients injured while under the influence of alcohol require more diagnostic tests, procedures, and hospital admissions, leading to higher hospital charges.

Methods: The National Trauma Databank (2000-2004) was analyzed to identify adult trauma patients (age >=16 years) who were discharged alive, had a length of stay <=1 day and minor injuries (Injury Severity Score <9), and were tested for blood alcohol. The study was confined to minimally injured patients to facilitate identification of unexpected resource use most likely attributable to alcohol use. Resource utilization was compared among patients who tested positive or negative for alcohol use. Results are presented as odds ratio (OR) with 95% confidence intervals (CI).

Results: Sixty-eight thousand eight patients met study criteria, of which 31,020 were positive for alcohol. Despite similar baseline characteristics, alcohol-positive patients required significantly more invasive procedures, including intubation (OR 4.16, 95% CI = 3.56-4.85) and Foley catheter insertion (OR 1.52, 95% CI = 1.39-1.67) as well as diagnostic tests (CT scan OR 1.16, 95% CI = 1.12-1.20). They were also less likely to be discharged from the emergency department (OR 0.61, 95% CI = 0.58-0.64), and more frequently required hospital (OR 1.64, 95% CI = 1.57-1.73) or intensive care unit admission (OR 1.82, 95% CI = 1.71-1.94). Mean hospital charges were $1,833 greater ($10,405 +/- 225 vs. 8,572 +/- 68).

Conclusions: A significant amount of trauma center costs are primarily attributable to alcohol use rather than injury severity or outcome. The financial costs associated with alcohol use and UPPL-related cost-shifting to trauma centers is a significant burden to trauma centers. UPPL laws that penalize trauma centers for identifying intoxicated patients should be repealed in states where they exist.

http://www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200902000-00031.htm;jsessionid=KL1YpD1JVpfdycJnpHW1DkX1N4nSrx0nChHHmZLzMc12DjYzsjWJ!762269091!181195628!8091!-1