Can a health insurance company refuse to pay for the ER treatment of a driver if they were at fault and DUI?

UPDATED: Jul 24, 2015

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Can a health insurance company refuse to pay for the ER treatment of a driver if they were at fault and DUI?

Asked on July 24, 2015 under Insurance Law, California


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 7 years ago | Contributor

A health insurer must pay for their insured's treatment within the the terms of the health insurance policy, which is a contract--and, as a contract, delineates the rights and obligations of the parties. If the policy contains some exemption allowing the insurer to not pay for medical treatment in the event of an at-fault license or DUI, then the insurer does not have to pay; but if the policy does not contain such an exemption, the insurer should have to pay.

A health insurer does not need to pay for the treatment of anyone who is not one its insured.

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