“I wanted to throw up:” Insurance won’t cover $54K medical bill because woman was drinking at the time

LOVELAND, Colorado -- We all know it’s legal to drink as much as you want in your own home. But when a Colorado woman tripped and fell on her face, her insurance company said 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 told KDVR.

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

“I`m 100% sure I would not have fallen if the sled would not have been there,” Mullins said, 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, stating: “Injury sustained that is due wholly or partially to the effects of intoxication or drugs is excluded under this policy."

Carol remembered her reaction upon reading the letter,

“I wanted to throw up because I couldn`t believe it. I knew we were in the $50,000 (range for medical bills)," Mullins said.

Mullins 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?” Mullins said.

 

An attorney for Mullins' insurance company KDVR 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 an HMO ever doing it and it’s not clear that Tokio Marine HCC qualifies as an HMO in Colorado.

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