Insurer Changes Policy on Power Wheelchair

Appeals Don't Get Far

Liam's furious grandmother, Amy Kaplan, decided to take on his battle for coverage.

"All the conversation is about the uninsured and the underinsured and I am trying to add a third category called the falsely insured," Kaplan said.

Kaplan's tireless efforts with the Oregon Insurance Commission did yield some results.

Assurant, which made $8 billion in gross profit last year, decided to offer the Russells a one-time payment of $2,549 toward the purchase of the $23,000 chair.

The company explained that "this decision is made in accordance with coverage provisions" and based on "13 months" of rental of manual wheelchair, which their policy covers.

"It was never explained why a child who is going to spend his life in the chair needs a rental for 13 months," Kaplan said.

And it was surprising to the Russells, since Assurant had repeatedly told them there were no coverage benefits for a power chair under their policy.

"We were denied again and again without any explanation other than they don't provide it," Russell said.

Kaplan asked about the change when she presented her case before Assurant's grievance panel.

"These actions and your low-end offers display not only bad faith denial of coverage, but arbitrary decision-making," said Kaplan during the April hearing, which was recorded on audio tape.

Despite her efforts, Kaplan was told she and her family had reached the end of the appeals process. Liam's power wheelchair would not be covered.

Grandmother Writes to 'GMA'

In desperation, Liam's grandmother wrote "Good Morning America" a letter asking for help in getting some answers.

"GMA" called Assurant and asked about Liam's case. After five months of no communication, Kaplan got a phone call from the office of Assurant's chief executive requesting a phone meeting. After the call, however, the power wheelchair was still not covered.

"They know it is wrong and no one is holding these corporations to reasonable accountability," Kaplan said.

ABC News' Chris Cuomo spoke to an Assurant senior executive, who refused to speak on camera about Liam's case.

Now, almost two years into the fight, the Russells are still out of pocket $23,000 for a wheelchair their son will outgrow when he turns 10.

"We're up against something that has to be changed," said Liam's father, Ben Russell. "I've heard people say, if it's not broke then don't fix it. I got news for you, folks. It's broken and we need to fix it."

After Cuomo's phone conversation with the senior executive at Assurant, the company issued a paper statement to "GMA" with an answer, saying they are commissioning a study to review the issue.

Assurant said: "While we must apply contract terms consistently to all policyholders, we understand the health care system is not perfect and the outcomes are not always ideal. We listen to the concerns of our customers, and are commissioning an industrywide study on this issue to see if and how all policyholders can benefit."

The family has set up a fund to help care for Liam:
"Liam Russell Supplemental Needs Trust"
c/o Moss Kaplan
2380 Fairfax Street
Denver, CO 80207

GMA Gets Answers Update

Our last story profiled Mary Casey who could not get the cancer drug Tarceva because the insurer called it experimental for her cancer. (Click here to read the story.)

Casey is now receiving the drug for free from a pharmacist who came forward and wanted to make the donation after our story ran. Casey's most recent test results show that her cancer has stabilized.

A group of attorneys also came forward after the story ran and are filing suit in federal court on Casey's behalf -- pro bono.

Click here for more information.

Click here to send Cuomo your case.

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