A New York individual accident and health policy includes the statutory intoxicants and narcotics provision. What does N.Y. Ins. Law §3216(d)(2)(K) permit under this provision?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under N.Y. Ins. Law §3216(d)(2)(K), an individual accident and health policy may provide that the insurer is not liable for a loss the insured sustains as a result of being under the influence of intoxicants or as a result of using narcotics, unless the narcotics were administered on the advice of a physician. The provision is a permitted exclusion for losses caused by intoxication or non-prescribed drug use, not a general benefit cut and not a ground for voiding the contract. A New York agent should explain at delivery that claims tied to intoxication or unauthorized narcotics can be legitimately denied.
Why the other options are wrong
- B) The provision permits exclusion of losses caused by intoxication; it is not an across-the-board reduction of every payment whenever alcohol is involved.
- C) The intoxicants and narcotics provision has nothing to do with motor vehicles; it keys on the insured's condition at the time of loss, not the type of accident.
- D) Voiding a policy for misstatements concerns representations and the entire-contract doctrine, not the intoxicants and narcotics exclusion.
Memory hook
§3216(d)(2)(K): drunk or drugged losses can be excluded - but a physician's orders keep coverage alive.