This is a true story but the names have been changed to protect the guilty. Your child has a single-car accident. S/he hits a tree. He was injured and taken to a hospital. The police come to the hospital and take blood. S/he is under 21 and has blood alcohol of .022. This is one beer or less. It is not a DUI if you are over 21 but under 21 it is a DUI if you are under 21. Your insurance company let’s just say for purposes of this hypothetical is ” BC/BS (Bull Cr*P/Bull Sh&t) of the State of Confusion” and insured this youth through the mother’s group policy from work. The health insurance company says that because the kid was drinking and driving they are denying coverage because of the exclusion below:
“Treatment of an illness contracted or injury sustained while engaged in the commission or an attempt to commit an assault or a felony; treatment of an injury or illness incurred while engaged in an illegal act or occupation; treatment of an injury or illness due to voluntary participation in a riot or civil disorder.”
Since Driving Under the Influence (DUI) is illegal, a crime, and a misdemeanor in Georgia (so is speeding by the way), they have an out. You say “that can’t be right.” You call your lawyer, he says, “That hardly seems fair. You paid your premium they should pay for your medical bills. I will get back to you.” Your lawyer calls back and says, “I have good news and bad news. The good news is that I feel so bad for you I don’t have the heart to charge you. The bad news is that the Georgia Court of Appeals says they are right and it looks like you are going to have to file bankruptcy or pay for the $100,000.00 (the rate for 2 days in the hospital when you are not paying the capitated health insurance rate or the Medicare/Medicaid rate)in medical bills that Georgia law says you are responsible for a child under 18 years of age.”
The Georgia Court of Appeals has held, “While [the insured] cites a Sixth Circuit case finding the word “crime” ambiguous because the insured is more likely to understand the word to mean burglary, armed robbery or murder than drunk driving, n7 we are not persuaded by this case.” Barnes v. Greater Ga. Life Ins. Co., 243 Ga. App. 149, 150 (Ga. Ct. App. 2000). Even worse, a claim was denied for the passenger in a car under a blanket accident policy when the driver crossed the center line in view of an exclusion for occupants of cars “driven in violation of any law or ordinance.” Burnette v. Ga. Life & Health Ins. Co., 190 Ga. App. 485 (Ga. Ct. App. 1989).