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'Illegal act' exclusion did not exclude coverage.(Legal Pulse)

Medical Benefits

| December 15, 2004 | COPYRIGHT 2003 Aspen Publishers, Inc. (Hide copyright information)Copyright

James Bekos was injured after he finished riding his motorcycle, got off, began pushing it, and then fell over it. A police officer responding to the scene placed Bekos under arrest for driving while under the influence of intoxicants; a lab test revealed a blood alcohol content of 0.25%.

As a result of the injuries sustained in the accident, Bekos incurred medical bills totaling more than $10,000. His insurer, Providence Health Plan, denied Bekos's claims based on the plan's "illegal act" exclusion, which excluded coverage for services and supplies that "relate to any condition sustained as a result of engagement in an illegal occupation, the commission or attempted …

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