State RegulationsNY specificDifficulty 2/5
A claims adjuster discovers that the insured was intoxicated at the time of the accident that produced the claim. Under the intoxicants provision of the New York individual accident and health policy, how is the claim affected?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under N.Y. Ins. Law §3216(d)(2)(K), the intoxicants provision permits the insurer to deny a loss sustained while the insured was under the influence of intoxicants. The adjuster may therefore decline this particular claim on that basis; the exclusion works claim by claim and requires no regulatory pre-approval. The policy itself remains in force for unrelated future losses.
Why the other options are wrong
- A) This overstates the insured's protection; New York law expressly permits the under-the-influence exclusion.
- B) The provision is a denial ground for the claim, not a cancellation route for the policy.
- C) No Superintendent approval is required to apply a standard contractual exclusion.
Memory hook
Intoxicated at loss time: the claim can be declined on the spot.