Mechanic in Wheelchair Credits 'GMA' for Victory Against Insurer

Paralyzed Mans Fight for Insurance Payment

Joe McKee loved riding Harley-Davidsons, saltwater fishing, and living life to the fullest. But in July 2008, his life changed forever. He was tearing down a concrete storage building in his backyard when one side of the wall fell on him, slamming him into the ground.

"I realized I couldn't move my legs," he said. "At that point I realized I couldn't, no matter what, I couldn't feel anything."

McKee, an aircraft mechanic and Marine veteran from Dayton Beach, Fla., was airlifted to the hospital, where doctors said he had suffered a severe spinal-cord injury. After several lengthy surgeries, McKee and his wife Sandi were given brutal news.

VIDEO: Mechanic in wheelchair was denied coverage for almost two years.
Paralyzed Vet Credits 'GMA' for Insurance Victory

"They came and told me that he would never walk again," Sandi McKee said.

Like approximately one in three Americans, McKee, 53, had an accidental death and dismemberment insurance policy. This type of insurance guarantees a lump-sum payment to you or your family in the event of a devastating accident or death. But critics say many of these insurance policies contain such vague and ambiguous terms that the insurer can try to avoid paying your claim when you need it most.

According to the policy, Cigna promised to pay McKee over half a million dollars if he submitted proof that that he met the policy's definition of paralysis, which is defined as total loss of use of his lower limbs.

The couple expected that because doctors told McKee he was bound to a wheelchair, Cigna would pay his claim and he would be able to renovate his home to accommodate his new life in a wheelchair.

But despite the medical evidence he submitted, Cigna Group Insurance denied McKee's claim and sent him a letter saying he could "ambulate and perform all ...activities of daily living." (CLICK HERE to read the denial from Cigna.)

"I cannot walk," McKee said. "How can I perform all the activities that I used to do before I was injured?"

McKee's lawyer, Tom Caldwell, says Cigna's statement was outrageous.

"He can obviously still brush his teeth, okay," Caldwell said. "But they -- the, the activities of daily living, most of them include the ability to ambulate, the ability to walk. He can't do that."

Dr. Carolyn Geis, a rehabilitation medicine specialist, disagreed with Cigna. She said that although McKee does have some movement in one leg and can use his upper body strength to drag his legs with a walker, he moves so slowly this way that it's just not useful.

"Mr. McKee has some movement, but he still meets the criteria of the insurance policy that he doesn't have use of his legs for any of the activities that he would normally do on a daily basis," Geis said.

So how could Cigna get away with refusing to pay McKee's paralysis claim for almost two years, even though his doctors said he is confined to a wheelchair for the rest of his life?

Critics say it is because insurance policies often contain vague terms -- terms like "loss of use," which was at issue in McKee's case -- which insurers try and interpret to their advantage.

Cigna declined an interview request from ABC News.

Because McKee's policy is governed by California law, "GMA" went to the California Department of Insurance for answers.

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