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Insurance refuses to cover Colorado woman’s $54K bill because of alcohol use

LOVELAND, Colo. — There's nothing illegal about having a few drinks in one's own home – but when a Colorado woman tripped and fell on her face, that's when her problems began.

Carol Mullins, of Loveland, says 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.

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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,” insisted Mullins, 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."

Carol 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 $50,000s (of medical bills).”

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

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An attorney for Carol’s insurance company told the FOX31 Problem Solvers 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.

If you’ve had a similar situation, you can file a complaint with the Department of Regulatory Agencies by calling 303-894-7490 / 800-930-3745 (outside the Denver metro area) or emailing DORA_insurance@state.co.us.