Woman owes $54K in medical bills because insurance company says she was intoxicated

insurance-denied

LOVELAND, CO (WCMH/KDVR) — A Loveland, Colorado woman is left holding a $54,000 medical bill for a fractured cheekbone after tripping in her own home.

Carol Mullins’ insurance company, Tokio Marine HCC, denied her claim because she was legally drunk.

“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.

The 55-year-old woman says she tripped over a sled her grandchildren left on the front porch. She denies that drinking several glasses of wine earlier in the night were the cause of her fall.

“I’m 100-percent sure I would not have fallen if the sled would not have been there,” Mullins said. “I was in my own home. I wasn’t out driving. Since when can’t you have a couple glasses of wine in your own home?” Her insurance company disagrees.

“Injury sustained that is due wholly or partially to the effects of intoxication or drugs is excluded under this policy,” the denial letter reads.

Vincent Plymell, the communications manager for the Colorado Division of Insurance, says he has never heard of this type of exclusion. He advised that she file a complaint against Tokio Marine HHC. While this type of exclusion may be legal for an HMO, it’s not clear Mullins’ insurance company qualifies as an HMO in Colorado.

A lawyer for Tokio Marine HHC simply said that the policy speaks for itself and that Mullins’ only recourse is to file an appeal.

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