Supporting Repeal of Certain Provisions of the Uniform 
Individual Accident and Sickness Policy Provision Law 

Whereas the Uniform Accident and Sickness Policy Provision Law (UPPL) states that "Intoxicants and Narcotics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician,” thus allowing insurers to deny payment for treatment of alcohol-related injuries, and

Whereas Washington and thirty-seven other states adopted the UPPL in their insurance codes, ten states rejected the UPPL, and five have recently repealed it, and

Whereas data from the Centers for Disease Control and Prevention indicate that emergency room physicians are significantly less likely to screen patients for an alcohol problem in UPPL states due to reluctance to potentially burden patients, even those drinking in a legal manner, with large medical bills caused by denial of coverage under UPPL, and

Whereas denial of coverage under UPPL also has a potentially large financial impact on emergency rooms, and

Whereas injuries are the leading cause of death in individuals less than forty-four years of age, the third leading cause of overall mortality, and the number one reason for ER visits, and

Whereas alcohol use is the leading cause of injury, and

Whereas forty to fifty percent of injured patients treated in ERs are under the influence of alcohol or other intoxicants, and

Whereas the UPPL was promulgated as a Model Law in 1947 when treatment for alcohol problems was generally not available, and regional trauma and emergency medical centers did not exist, and

Whereas there are over 40 studies evaluating the use of brief alcohol interventions in health care settings, including ERs and trauma centers, that document effectiveness in reducing subsequent alcohol intake, DUI's, alcohol-related traffic infractions, alcohol-related arrests, and injury-related hospital readmissions, and

Whereas cost-benefit analysis conducted at the University of Washington demonstrates that ER screening and intervention will result in an estimated three year net national savings of $1.82 billion in direct medical costs, which are estimated to be 15% of total costs, with the remainder due to property damage, and that $4 will be saved for every dollar invested in this kind of intervention, and

Whereas a variety of federal, expert, public policy, and advocacy groups recommend routine ER screening and intervention for alcohol use, and urge amendment of the UPPL because it is a significant barrier to such cost-effective intervention, and

Whereas currently fewer than 15% of injured patients treated in ERs are screened for alcohol use and referred for counseling, and

Whereas such amendment will not increase insurance costs because insurers cannot deny the charges if the medical record does not document alcohol use.  In jurisdictions where the UPPL is enforced physicians have responded by not measuring and documenting alcohol use.  Thus, though insurers already pay for treatment of alcohol-related injuries, the opportunity to screen and refer patients is missed,

Now therefore be it resolved that the Washington State Public Health Association supports and endorses repeal of Chapter 48.20.272 RCW of the Uniform Individual Accident and Sickness Policy Provision Law allowing for denial of insurance payments for the treatment of injuries sustained when the insured person is intoxicated or under the influence of narcotics.

Signed by: John Wiesman, WSPHA President 2002-2003