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health claims denied


Guest annaleah

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Guest annaleah

My brother is parapleigic as a result of a single car accident. Can his health insurance company not pay claims made for medical expenses as a result of a car accident because of Blood Alcohol Level? The health insurance company has been directed by the employer to stop paying because of this. What are his rights, where can he go for guidance?

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This will depend on the how well this is described in the contract. Presumably, this is there...if they are just applying this as a rule without it being in the contract, you have something to fight over. If it was clearly stated in the contract, then you may not have an argument unless there is a law in your state overriding such a clause.

Note that a recent court case (and appeals court) upheld a similar insurer's clause in a LIFE insurance contract. The clause was obviously written as a way to not pay when the "accident" was in conjunction with being over the "legal blood alcohol limit" in that state. However, the person died in bed from regurgitating and choking. Because the person's blood alcohol was over the legal limit for driving, the courts upheld the clause that no death proceeds would be made...even though the person did not die as a result of anything related to driving.

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