The impact of the Uniform Accident and Sickness Policy Provision Law on alcohol consumption
and alcohol consumption related outcomes
Project Summary
The Uniform Accident and Sickness Policy Provision Law (UPPL) in many U.S. states’ insurance
codes are intended to discourage problem drinking by permitting insurance companies to deny
claims for injuries resulting from alcohol impairment or the use of non-prescribed narcotics.
Although the primary intention behind UPPLs was to discourage excessive drinking and
substance use, evidence suggests that these laws have unintended consequences, as they
crease a disincentive for physicians to test the blood alcohol concentration (BAC) levels of
injured patients due to concerns about potential insurance reimbursement denials. Recognizing
this, a major stakeholder, the National Association of Insurance Commissioners (NAIC), changed
its stance in 2001 to support health insurance coverage regardless of intoxication status.
However, despite this shift, many states still retain their UPPLs. The existing literature on the
impact the UPPL on alcohol consumption and alcohol consumption related outcomes is mostly
descriptive and studies that provide a credible estimation methodology focus on the effects of
UPPLs on a very limited number of outcomes. Furthermore, existing studies focus on the effects
of the repeal of UPPLs. However, repeal of the UPPL does not guarantee that insurance
companies cannot deny claims resulting from alcohol impairment unless the repeal of the UPPL
was simultaneously occurred with the introduction of another law that explicitly prohibited the
denial of claims due to intoxication. Some states either did not have a UPPL law to begin with or
did not introduce any law that prohibits denial of insurance claims due to alcohol involvement
following the repeal of the UPPL. In these states, without the existence of any law that explicitly
prohibits denials, courts have ruled that insurance companies can still deny claims due to
alcohol involvement. Therefore, a more accurate assessment of the effectiveness of the UPPLs
should rely on separate comparison of the outcomes of the states where denial is explicitly
permitted with those where denial is prohibited and those where no UPPL related law exists.
The proposed project will be the first to provide a comprehensive analysis of the effects of the
UPPLs on alcohol consumption both at the intensive and extensive margin. In addition to its
effects on alcohol consumption, the proposed project will also be the first to provide evidence
on the spillover effects of these laws on alcohol related outcomes such as drunk driving
behavior, alcohol and drug related traffic fatalities, driving under influence (DUI) arrests,
number of emergency department (ED) visits, and out-of-pocket healthcare expenses for alcohol
and drug related ED visits. We will exploit the variation in UPPLs across different states and over
time to conduct event study and difference-in-differences (DID) analyses of the effect of the
policy on alcohol consumption and related outcomes. The results from this study will provide
policy makers with new, important information about the effectiveness of UPPLs and contribute
to the recent policy discussion on whether these laws should be repealed.
