Insurance won’t cover $54,000 bill because of alcohol use

LOVELAND, Colo. -- When a Loveland woman tripped and fell on her face inside her home, her insurance company said the she wasn’t covered because she was legally drunk.

Now, Carol Mullins has a $54,000 medical bill for a fractured cheekbone.

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“These insurance companies, they take and take and take and as soon as you have a claim, sorry, can't help you,” Mullins said.

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The 55-year old said she tripped on her front porch on the evening of March 28, after her grandchildren left a sled partially hidden behind a chair.

“I'm 100 percent sure I would not have fallen if the sled would not have been there,” said Mullins, denying her several glasses of wine earlier that night were to blame.

But her insurance company, Tokio Marine HCC, sent her a denial of coverage letter, saying, "Injury sustained that is due wholly or partially to the effects of intoxication or drugs is excluded under this policy."

Mullins remembered her reaction upon reading the letter.

“I wanted to throw up because I couldn't believe it because I knew we were in the 50 thousands (of medical bills)," she said.

insurance-denialMullins said the fall would’ve happened if she had been stone cold sober and feels insurance is for accidents.

“I was in my own home.  I wasn't out driving. Since when can't you have a couple of glasses of wine in your own home?” she said.

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An attorney for Mullins' insurance company said the policy speaks for itself but suggested Mullins file an appeal.

Vincent Plymell, the communications manager for Colorado’s Division of Insurance, suggested Mullins file a complaint with the Department of Regulatory Agencies because his office had never heard of such an exclusion.

Plymell said it might be legal for an HMO to deny such a claim, but he’s unaware of one ever doing it, and it’s not clear that Tokio Marine HCC qualifies as an HMO in Colorado.

Anyone with a similar situation can file a complaint with the Department of Regulatory Agencies by calling 303-894-7490 or 800-930-3745 (outside the Denver metro area), or email DORA_insurance@state.co.us.