Insurer Changes Policy on Power Wheelchair

An insurance company changed its policies on covering motorized wheelchairs after a review of its guidelines, sparked in part by a 3-year-old boy's story on "Good Morning America."

Initially, Assurant denied Liam Russell's claim for a power wheelchair, much to the surprise of his parents.

Liam, who has a rare degenerative disease called type 2 spinal muscular atrophy, needed a power wheelchair to ensure his independence, his parents said.

"I remember getting a phone call saying, 'Assurant is denying benefits." And I said, 'Completely?" And they said, 'Yes." They don't, they don't cover power chairs, end of story," Liam's mother Lynn Russell said.

Assurant now will cover motorized wheelchairs for all its individual policy holders, not just Liam. The company's decision could have even broader implications because not covering power wheelchairs is an industry-wide issue.

While the news may be good for the insurer's clients, Liam's parents didn't wait for a policy change. The Russells were able to raise money to purchase the special chair, which can cost more than $30,000.

Find out more about Liam's story below.

When Liam Russell was about a year old, his parents noticed a decline in his physical abilities.

"I just expressed some concern that he wasn't pulling up to his knees," said Liam's mom, Lynn Russell. "He didn't seem to be crawling quite as much."

Eventually, Liam was diagnosed with a rare degenerative disease called type 2 spinal muscular atrophy.

"The hardest thing was calling the pediatrician," Lynn said. "I just thought she would say I was imagining things. I didn't know that it was a lifelong illness."

Doctors say Liam will never be able to walk. Already, his arms and legs are so weak he cannot even sit up on his own. "He can't roll by himself, if he is thirsty he can't sit up and get water," Lynn said.

There was one thing that doctors said could help him lead a more independent life -- a power wheelchair. "We decided to try to get him a power wheelchair right away," Lynn said.

Coverage at Insurer's Discretion

But when the Russells submitted a claim to their insurer, Assurant, they were denied coverage of the wheelchair.

"I remember getting a phone call saying that Assurant is denying benefits and I said, 'Completely?' And they said, yes, they don't cover power chairs, end of story," Lynn said.

But according to their policy, they were covered for "durable medical equipment" that the insurer determines to be covered -- vague language leaving Assurant free to cover what they want.

Consumer advocates say health insurance companies often write policies in a way that gives them flexibility to deny claims.

"In black and white in that policy it says we will determine what coverage to provide," said Gail Shearer of Consumer's Union. "That doesn't give a lot of power to the consumer. That's one enormous loophole."

Instead they offered the Russells a manual wheelchair, which Liam couldn't manage to use on his own.

"I think the language in the policy is confusing and meant to be confusing," Lynn said. "The bottom line is that they are a money-making business, and paying out for power chairs probably doesn't look good in their checkbook."

After two appeals, Assurant still wouldn't cover Liam's chair.

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