Social Work and the Uniform Accident and Sickness Policy Provision Law: A Pilot Project
Cochran, Gerald, Davis, King, Social Work
Twenty-four percent to 31 percent of annual emergency department (ED) visits and 50 percent of severe traumatic injuries seen in hospitals in the United States are related to alcohol intoxication (D'Onofrio & Degutis, 2002; Gentilello et al., 1999). However, only 4 percent of visits to EDs have been found to be related to drug use (Cherpitel & Ye, 2008). Because of the prevalence of alcohol and drug use by patients, medical settings represent a feasible venue for clinical interventions. Kesearch trials over the past 30 years have supported the efficacy of screening and brief interventions (SBIs) in reducing future alcohol use and creating improved health care outcomes, such as reductions in injury recidivism (D'Onofrio & Degutis, 2002; Nilsen et al., 2008). Support for SBIs is such that the American College of Surgeons (ACS) requires that trauma centers deliver these services to receive level 1 accreditation (ACS, n.d.).
Within clinical settings, a variety of professionals see and treat individuals who suffer injuries related to alcohol and drug use. Among these professionals are social workers, who play an important role in the care of injured patients. In particular, social workers are often trained and charged with alcohol and drug use screenings and interventions--including SBIs (ACS, n.d.; Bliss & Pecukonis, 2009). Regardless of whether substance abuse--related services are delivered by social workers or trauma surgeons, a law existing in many states allows insurers to deny health care claims for people injured as a result of alcohol or drug intoxication. This law has serious repercussions for the nation's health care system, health care professionals, and their individual patients.
The National Association of Insurance Commissioners created a model state statute (template law) in 1947 named the Uniform Accident and Sickness Policy Provision Law (UPPL). The original text of the law stated, "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" (Alcohol Policy Information System, 2008). The purpose of this law was to exempt health insurance companies from paying medical expenses for individuals who suffered injuries related to alcohol or ding intoxication (Chezem, 2004; Gentilello et al., 2005).
After the UPPL was authored, it was subsequently passed into law in 38 states and provisionally passed (narcotics only) in four states (Gentilello et al., 2005; Rivara, Tollefson, Tesh, & Gentilello, 2000). Over the past 50 years, 16 states have repealed or amended the statute, and today 26 states (see Table 1) continue with the UPPL in force in their health insurance codes (Baker, 2009). Recent content analyses of each of these 26 states' UPPL statutes demonstrated that the statutory language remains highly similar in form and intent to the original (1947) UPPL text, and the law has experienced few, if any, changes in these 26 states since its inception (Cochran, 2010).
Unfortunately, empirical research about how much and how frequently payment for substance use--related injuries is denied by insurers is not present within the literature. Nevertheless, despite this absence of data, the threat of the UPPL has been substantiated by findings from a survey reporting that nearly 25 percent of surgeons sampled had seen a denial of insurance payment for substance use-related injuries within the previous six months of their practice (Gentilello et al., 2005). The seriousness of claim denials is also reflected in the policy priority of the ACS that aims to overturn the law in the states in which it exists (ACS, 2009), anecdotal victim accounts (Zimmerman, 2003), and state insurance lobbyist testimony (Texas House of Representatives, 2007).
Despite the reality of the UPPL, some may insist that current federal laws exist to protect individuals who have received substance abuse treatment services--as might be delivered in medical settings following substance use-related injuries. …