Insurance law technicality leaves Nebraska couple bankrupted by medical emergency

Published: Jan. 28, 2020 at 10:06 PM CST
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Ashley, 31, and Nathan Werner, 28, are an Alvo, Neb., couple who had dreams of starting a family a few years ago. Now, they are trying to climb out of Chapter 13 bankruptcy.

"We're just drowning in debt," Nathan said shaking his head.

It began in July 2017. The couple and some friends were building an above-ground pool in their backyard. The walls were built, and the pool was filling up when Nathan decided to test the waters.

"How you jump over a fence — that's what I was doing. But my foot was dangling just enough that it got caught and spun me around," Nathan said sitting next to his wife at their kitchen table.

Nathan landed head-first in about six inches of water.

"I see him fall, and I go, ‘He hit his head,’ " Ashley said, recalling the event.

She watched as Nathan's life changed forever.

"I was underwater, face first, not able to move and just wondering what had happened," Nathan said.

Nathan instantly lost all movement below his shoulders.

At the hospital, X-rays showed a burst fracture in the C-5 vertebrae.

“They pretty much told me I'd be paralyzed for the rest of my life," Nathan said.

Nathan was rushed into surgery, and Ashley got to work — this was going to be a long and expensive recovery. They called their insurance company, and the situation went from bad to worse.

"They kept bringing up the intoxicated part. That was their reasoning," Ashley said, looking over at Nathan.

Nathan had been drinking when he got hurt and a little-known insurance clause meant the Werners’ were getting no help from their insurance provider.

"The alcohol-exclusion clause allows insurance companies to put a policy into people's health insurance that allows them to exclude payment if it's found they were under the influence of alcohol when they were injured," said Seth Woodkey, director of Metro Community College's insurance program.

Created in the 1940s, this loophole was meant to limit people's access to alcohol and prevent DUIs. But according to publications from several major medical journals, this isn't the case.

"In today's world, not a lot of people are aware of it, and I think it's hard to curtail something that people don't even know is in the contract," Woodkey said.

And if people are aware of the clause, it could lead to bad decisions.

"People might wait to get medical treatment for something,” Woodkey said. “As well, hospitals and doctors, they might try not put someone through blood-alcohol test because they're thinking it's possible this might not get covered by insurance, and that increases the likelihood they might not get paid.”

For two years, the Werners submitted appeals, worked with social workers and lawyers to get help, but each appeal was denied.

They were financially tapped dry.

"[We felt] betrayed,” Nathan said. “A waste of money. We were paying quite a bit of money every month for that reason and got nothing out of it.”

Nathan had to learn to feed himself, sit up, and eventually was able to walk again — all while racking up lingering side-effects and around $300,000 in medical expenses their insurance didn't pay a penny on.

The Werners don't know whether they will ever financially recover but are now looking for someone who can help them make sure no one else ends up in their shoes.

"I do think we need to get rid of the law, I really do," Ashley said.

"We spent a lot of money on insurance, and if you're not doing anything illegal, it would be nice for the insurance company to cover you," Nathan agreed.

According to the

, Iowa is one of 12 states to get rid of the clause outright. Nebraska is one of 30 states that allows it in some form.