An insured suffers a severe reaction to a painkiller prescribed by her physician after surgery and is hospitalized. Her individual health policy contains the intoxicants and narcotics provision. How should the claim be handled?

Why B is correct

Under N.Y. Ins. Law §3216(d)(2)(K), the intoxicants and narcotics exclusion does not apply where the narcotics were administered on the advice of a physician. Because the painkiller was prescribed by the treating physician, the loss is not excludable and the claim must be paid like any other covered sickness loss. The physician exception is the classic distinction that examination items test on this provision.

Why the other options are wrong

• A) The exclusion does not reach narcotics taken as prescribed; it targets losses from drug use outside a physician's advice.
• C) There is no reduced-percentage payment rule for prescribed medication; the claim is payable in full under the policy's terms.
• D) Physician negligence would raise a malpractice question, not the intoxicants and narcotics exclusion; the exclusion keys on the insured's own drug use.

Memory hook

Doctor's orders beat the exclusion - physician-advised narcotics stay covered.