Alcohol exclusions within insurance policies permit insurers to deny coverage to people injured while under the influence of alcohol. Exclusions can be used to deny payment to medical payments to doctors and hospitals. Some states laws are more lenient (requiring proof only of alcohol use prior to injury) and others being more strict (requiring proof of a causal relationship between the use of alcohol and the injury).

The National Association of Insurance Commissioners (NAIC), the organization of insurance regulators in the 50 states, adopted the Alcohol Exclusion Law in 1947. Forty-two states and the District of Columbia subsequently adopted a version of the Alcohol Exclusion Law. In 2001, the NAIC unanimously recommended states repeal the Alcohol Exclusion Law and prohibit the denial of coverage for individuals injured while under the influence of alcohol or narcotics.

The National Highway Transportation Safety Administration (NHTSA) speaks about alcohol exclusion and they sought to determine the legal ability of insurance carriers to deny coverage for the trauma care of a patient who was intoxicated at the time of injury. They did so by seeking data from the insurance commissioners in all 50 states.

Of the 31 states that complied, 26 stated that an exclusion of coverage would be allowed if the insured person was intoxicated at the time of injury. The majority of the respondents claimed that if the insurance contract, agreed to by the patient, contained a specific exclusion for injuries due to intoxication, the insurer can legally deny coverage for the care.

Many state insurance commissioners expressed the sentiment that policies will not cover injuries sustained while intoxicated because these injuries are viewed as self-inflicted or self-induced. That is, by drinking alcohol, people knowingly put themselves in harm’s way. In their view, denying a claim based on the provision that the carrier is not liable for coverage of injuries sustained under the influence of alcohol is similar to denying coverage for self-inflicted injuries in a suicide attempt.

With that background about alcohol exclusion, the latest information we were able to find noted that 32 states (and the District of Columbia) have alcohol exclusion laws in practice while ten others "allow" for alcohol exclusion policies by not explicitly prohibiting them.

Since 2001 there have been ten (10) states that we are aware of that have amended or repealed alcohol exclusion laws. These 10 states include Colorado, Connecticut, Iowa, Maryland, Nevada, North Carolina, Rhode Island, South Dakota, Vermont, and Washington. Colorado's legislature passed a law in April 2006 that prohibits alcohol exclusion insurance policies. Connecticut's legislature passed similar legislation in May 2006.

In the first half of 2007, legislation to repeal alcohol exclusion laws introduced in California, the District of Columbia, Illinois, Indiana, Ohio, Oregon, South Carolina, and Texas. Repeals have already passed in the District of Columbia, Illinois, Indiana, and Oregon.

So it is our understanding that Oregon now prohibits insurers from using alcohol exclusions. Since court rulings and legislature vary by state, to find out the exact status on alcohol exclusion and what the recent changes to the Oregon Statutes say specifically regarding this issue, check with the OR Insurance Division. You may also want to research the matter by going through the Oregon Legislature site.