State RegulationsNY specificDifficulty 3/5
A covered person's loss resulted from a drug that was administered on the advice of her physician. Under the standard intoxicants and narcotics provision of her New York individual accident and health policy, the insurer:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under N.Y. Ins. Law §3216(d)(2)(K), the standard intoxicants and narcotics provision excludes loss sustained while the insured is under the influence of intoxicants or narcotics, unless administered on the advice of a physician. Because the drug here was administered on the advice of the insured's physician, the narcotics prong does not reach this loss and the claim cannot be denied on that basis.
Why the other options are wrong
- A) This ignores the carve-out for drugs administered on the advice of a physician.
- C) A medication prescribed by and taken on the advice of a physician remains within the carve-out, not the exclusion.
- D) No duty to deny arises, and reporting the physician to the Superintendent is not part of this provision.
Memory hook
Doctor-ordered drugs dodge the narcotics exclusion.