Insurance Refuses to Cover Woman’s $54K Bill Because of Alcohol Use

KTLA 5 News

By Tribune Media Wire

September 19, 2016

A few glasses of wine at home came with a $54,000 price tag for one Colorado woman after she tripped over a sled left out by her grandchildren and fell on her face.

Loveland resident Carol Mullins told KTLA sister station KDVR her insurance company refused to cover her medical bills because she was legally drunk. Now, Mullins has a $54,000 medical bill for a fractured cheekbone.

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

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,” Mullins said, denying that the several glasses of wine she drank 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.”

“I wanted to throw up because I couldn’t believe it because I knew we were in the $50,000s (of medical bills),” Mullins said of her reaction upon receiving the letter.

Mullins said the fall would still have happened if she were completely sober and feels insurance is for accidents.

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

An attorney for Mullins’ insurance company told 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 a health maintenance organization, or HMO, to deny such a claim but he’s unaware of one ever doing so, and it’s not clear that Tokio Marine HCC qualifies as an HMO in Colorado.