Insurance attorneys in Dallas County need to be able to know how the courts interpret exclusions in policies when the exclusions rule out coverage for injury resulting from intoxication of narcotics. The United States Western District Court in Austin issued an opinion in June of 2015, dealing with this issue. It is styled, Eleanor Crose v. Humana Insurance.
This is an adverse ruling to Crose involving a summary judgment.
Crose is insured under a health insurance policy issued by Humana. Crose suffered a stroke which left him mentally and physically impaired. He filed a claim which Humana rejected citing a policy exclusion rendering benefits non-payable when the insured’s injury is “due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner.” Crose sued for violations of the Texas Insurance Code Sections under 541.060 and 542.051.