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Drunken Drivers May Find Insurance Won’t Pay the Bills for Their Injuries

July 6, 1995

Here’s another reason not to drink and drive: If you’re in an accident, your medical bills may not be paid by your insurance.

Chief Auto Parts Inc. in Dallas last year added drunken-driving injuries to the list of exclusions in its health plan. Monfort Inc. of Greeley, Colo., did the same last year after an appeals court upheld its denial of a $250,000 claim for a drunken-driving accident. And Electronic Data Systems Corp. recently circulated an employee newsletter warning that ``drinking, driving and medical benefits don’t mix.″

Companies say employees who don’t drink and drive shouldn’t be forced to help cover those who do. They also note that drunken driving is a crime. ``Common sense says that we don’t want to cover″ injuries sustained during any illegal act, says a spokesman for EDS, a unit of General Motors Corp. (EDS does pay for the injuries of passengers who are covered under its health plan.)

The main incentive is economic. ``A lot of companies just aren’t aware of the savings they can have with these exclusions,″ says Lynn Ashley, benefits manager at Chief Auto.

Critics complain that the exclusions are inconsistent because they don’t apply to other risky behavior such as eating high-fat diets or playing dangerous sports. Moreover, because many medical experts consider alcoholism an illness, some observers say that denying alcohol-related claims in cases involving alcoholics could violate the Americans With Disabilities Act. The exclusions ``are not square with the current view of alcoholism, which is seen as a disease or disability,″ says Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics.

Drunken-driving exclusions can also be difficult to enforce. To deny a claim, companies need to know an employee’s blood-alcohol content during an accident. But while traffic cops usually give breath tests, medical workers often don’t, especially if the injured get to the hospital themselves. Moreover, the increasing automation in claims-paying offices means that claims are scrutinized less closely for grounds for an exclusion, says Elizabeth Igleheart, a benefits consultant at Towers Perrin in Dallas.

And even supporters concede that the consequences of the drunken-driving exclusion can be devastating. ``I’ve seen the personal result of these exclusions, which isn’t pretty,″ says Bernard Baum, a Chicago attorney who represents several insurance funds that pool companies’ money. ``You can have a paraplegic without insurance who could be your employee or your mother or husband,″ he says, though ultimately he applauds his clients for discouraging drinking and driving.

Companies that won’t cover drunken-driving injuries are often self-insured, meaning they pay employees’ medical bills out of pocket, benefits experts say. Self-insured companies can generally craft their own lists of exclusions because they’re usually free from states’ mandates about what they must cover.

Health-benefit consultants say the drunken-driving exclusion is part of an increasingly popular carrot-and-stick approach that encourages employees to take personal responsibility for their health care. Some companies refuse to cover injuries or illnesses that they consider self-inflicted, such as AIDS. On the flip side, some companies reward employees who exercise or get preventive care by reducing out-of-pocket medical expenses or giving cash rebates.

But some observers say they see the fingerprints of Carry Nation. They note that most of the companies implementing the drunken-driving exclusions are located in the South or Midwest, where there’s a history of teetotaling, dry counties and religions that prohibit drinking.

In a recent employee newsletter on benefits, Dallas-based EDS issued a warning about drinking any amount at all. It said that a traffic wreck ``can be considered alcohol-related″ if the driver’s blood alcohol concentration is ``.01 grams or greater.″ The legal limit of intoxication in most states is 0.1 gram of alcohol per 100 milliliters of blood, and a company spokesman concedes that EDS’s exclusion applies only to workers above the legal limit.

Most companies with exclusions are willing to pay for rehabilitation for workers with drinking problems. Chief Auto goes a step further and insists that the driver agree to get help before it will pay for drunken-driving injuries. ``If they’re in denial, they’re not covered,″ says Ms. Ashley.

Even companies that don’t explicitly refuse to cover drunken-driving accidents still deny benefits in some cases. Health plans at NorAm Energy Corp. of Houston and Arkansas Best Corp., a trucking company in Fort Smith, Ark., won’t pay for injuries to employees who are hurt while committing a felony. That would include some drunken-driving offenses.

Others, such as Monfort, a meatpacking company, exclude coverage even for first-time offenders. The company added its drunken-driving exclusion last year after an appeals court upheld its denial of a $250,000 medical bill submitted by an employee whose insured wife suffered brain damage when she crashed her car while intoxicated. She had no prior drunken-driving record.

At Chief Auto, benefits are denied workers injured not only in drunken-driving accidents but also in a category called ``dangerous sports,″ which includes bungee jumping, scuba diving and hang-gliding. One exception: Employees of the auto-parts purveyor are covered for any injuries they get in auto races.

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