An accident and health insured suffers a loss while intoxicated. However, the intoxication stemmed in part from a prescription drug administered on the advice of his physician. Under the intoxicants-and-narcotics provision of 40 P.S. § 753(B)(11), how should the claim be treated?

Why A is correct

The intoxicants-and-narcotics provision of 40 P.S. § 753(B)(11) excludes losses sustained while the insured is intoxicated or under the influence of narcotics, but it carves out narcotics administered on the advice of a physician. That physician-administration exception is what saves claims arising from medically supervised drug use, while self-induced intoxication remains excluded.

Why the other options are wrong

• B) Intoxication is a recognized basis for denying the loss under 40 P.S. § 753(B)(11); it is only the physician-administered narcotics exception that restores coverage.
• C) There is no treatment-program condition in the provision; coverage turns on the source of the intoxication, not on rehabilitation.
• D) The remedy for an excluded loss is nonpayment of that loss, not voiding the policy and refunding premiums.

Memory hook

Doctor's drugs are forgiven; the bottle is not.